Lee Sang Gyu, Jee Young Geon, Chung Hyun Chul, Kim Sung-Bae, Ro Jungsil, Im Young-Hyuck, Im Seock-Ah, Seo Jae Hong
Department of Preventive Medicine, Dankook University College of Medicine, San#29, Anseo dong, Cheonan, Chungnam 330-715, Korea.
Breast Cancer Res Treat. 2009 Apr;114(3):589-95. doi: 10.1007/s10549-008-0035-0. Epub 2008 Apr 25.
This study evaluated the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) of TAC compared with FAC following primary surgery for node positive breast cancer patients in Korea.
A cost-effectiveness analysis was performed using the Markov model from the combined view of Korean National Health Insurance and patients. The model allowed assessment from the beginning of the first cycle of adjuvant chemotherapy following primary surgery until death. Relevant clinical data were obtained from the clinical trial BCIRG 001 and data for local treatment patterns and direct medical costs were obtained from three Korean hospitals.
Over a life time horizon, the life expectancy of TAC was 0.9 years longer than that of FAC. The ICER was 8,025,879 Korean won (KW, 6,573 euro) per life year gained and the ICUR was 8,885,794 KW (7,277 euro) per QALY gained when the cost and effectiveness were discounted at 5%. The model was most sensitive to the percent patient receiving prophylactic granulocyte colony stimulating factor (G-CSF) in TAC arm and the ICUR was 12,119,561 KW (9,926 euro) when assuming 100%.
TAC appears to be cost-effective in the management of early breast cancer in Korea.
本研究评估了在韩国，对于淋巴结阳性乳腺癌患者，辅助化疗方案多西他赛联合阿霉素及环磷酰胺（TAC）与氟尿嘧啶联合阿霉素及环磷酰胺（FAC）相比的增量成本效果（ICER）和成本效用比（ICUR）。
从韩国国家健康保险和患者的综合视角出发，使用马尔可夫模型进行成本效果分析。该模型可评估从初次手术后辅助化疗第一个周期开始直至死亡的情况。相关临床数据取自临床试验BCIRG 001，局部治疗模式及直接医疗成本数据取自韩国的三家医院。
在整个生命周期内，TAC组的预期寿命比FAC组长0.9年。当成本和效果按5%贴现时，每获得一个生命年的ICER为8,025,879韩元（KW，6,573欧元），每获得一个质量调整生命年（QALY）的ICUR为8,885,794 KW（7,277欧元）。该模型对TAC组中接受预防性粒细胞集落刺激因子（G-CSF）的患者比例最为敏感，假设为100%时，ICUR为12,119,561 KW（9,926欧元）。
在韩国，TAC方案在早期乳腺癌治疗中似乎具有成本效益。
