Carlson Josh J, Veenstra David L, Ramsey Scott D
School of Public Health and Community Medicine, Institute for Public Health Genetics, University of Washington, Seattle, Washington, USA.
Drugs. 2008;68(8):1105-13. doi: 10.2165/00003495-200868080-00007.
Non-small cell lung cancer (NSCLC) creates a large economic and disease burden worldwide. In an era of evidence-based medicine and increasing cost pressures, it is important to understand the relative clinical and economic impact of the many drug treatment strategies available for NSCLC. A systematic review of the peer-reviewed literature for pharmacoeconomic evaluations in the primary treatment of NSCLC published over the past decade (1 June 1997 to 1 June 2007) was conducted using the PubMed, EMBASE, BIOSIS Previews, Harvard Review of Economic Analyses, National Institute for Health and Clinical Excellence and Canadian Agency for Drugs and Technologies in Health databases. A total of 19 studies met the inclusion/exclusion criteria. Of these studies, 58% were cost-effectiveness studies, 37% were cost-minimization studies and 5% were cost-utility studies. Most were from the EU (63%), were from the payer perspective (89%), were in advanced (stage IIIB/IV) NSCLC (84%) and were funded by drug manufacturers (68%). Drug treatments generally were found to be cost effective compared with best supportive care. In addition, cisplatin alone or in combination appeared to provide better value than carboplatin alone or in combination. We did not identify any studies of recently approved therapeutics (e.g. erlotinib or bevacizumab). The quality of studies varied but the majority did not meet recommended guidelines for economic evaluations, with only 43% using direct comparisons, 5% of studies being cost-utility studies and 26% using either statistical analysis of patient-level data or probabilistic sensitivity analyses. In conclusion, there are a multitude of studies examining drug treatment for NSCLC; however, few of these utilized methodological approaches consistent with recommended guidelines. Despite these limitations, it appears that drug therapy compared with no treatment provides reasonable value for money, but carrying out more detailed comparisons of various agents is challenging. Given the absence of studies on newer therapeutics and the lack of cost-utility studies, additional studies are warranted.
非小细胞肺癌（NSCLC）在全球造成了巨大的经济和疾病负担。在循证医学时代以及成本压力不断增加的情况下，了解NSCLC多种药物治疗策略的相对临床和经济影响非常重要。我们使用PubMed、EMBASE、BIOSIS Previews、《哈佛经济分析评论》、英国国家卫生与临床优化研究所及加拿大卫生技术评估局数据库，对过去十年（1997年6月1日至2007年6月1日）发表的关于NSCLC一线治疗药物经济学评价的同行评议文献进行了系统综述。共有19项研究符合纳入/排除标准。在这些研究中，58%为成本效益研究，37%为成本最小化研究，5%为成本效用研究。大多数研究来自欧盟（63%），从支付方角度进行（89%），针对晚期（IIIB/IV期）NSCLC（84%），由制药商资助（68%）。与最佳支持治疗相比，药物治疗总体上被认为具有成本效益。此外，顺铂单药或联合用药似乎比卡铂单药或联合用药更具价值。我们未发现任何关于近期获批疗法（如厄洛替尼或贝伐单抗）的研究。研究质量参差不齐，但大多数未达到经济评价的推荐指南，只有43%采用直接比较，5%的研究为成本效用研究，26%采用患者层面数据的统计分析或概率敏感性分析。总之，有大量研究探讨NSCLC的药物治疗；然而，其中很少有采用符合推荐指南的方法学。尽管存在这些局限性，但与不治疗相比，药物治疗似乎具有合理的性价比，但对各种药物进行更详细的比较具有挑战性。鉴于缺乏关于新型疗法的研究以及成本效用研究的匮乏，有必要开展更多研究。
