Lobo P J, Powles R L, Hanrahan A, Reynold D K
Medical Department, Farmitalia Carlo Erba (UK), Limited, St Albans, Hertfordshire.
BMJ. 1991 Feb 9;302(6772):323-6. doi: 10.1136/bmj.302.6772.323.
To measure the effects of changes in treatment of acute myeloblastic leukaemia that may give better value for money.
Retrospective analysis of patients' notes to identify items of management costing money; prospective costing of these items. The Medical Research Council acute myeloblastic leukaemia 9 trial was used to identify the amount and distribution of these costs when either one or two courses of induction treatment were required to obtain complete remission. These findings were then extrapolated to four published international controlled trials using similarly intense treatment and in which the number of courses of treatment required for complete remission was stated, to compare British costs for treatment with idarubicin and daunorubicin, both in combination with cytarabine.
Leukaemia unit, Royal Marsden Hospital, London.
Data on 10 patients receiving intensive induction treatment for acute myeloblastic leukaemia were used to identify 160 items of cost in four broad groups: general (including accommodation), diagnostic, supportive treatment, and cytotoxic chemotherapy. One newly treated patient was prospectively assessed over one month, including a time and motion study, to cost these items; then costs for 268 patients from the MRC trial receiving moderate induction chemotherapy including daunorubicin were assessed, and costs for treatment of 522 patients in the four international studies comparing daunorubicin with idarubicin were analysed.
Cost effectiveness was measured as the overall cost to obtain complete remission in untreated patients with acute myeloblastic leukaemia after treatment with idarubicin or daunorubicin.
The 160 costed items were measured for their sensitivity in varying the total cost of treatment, this being assessed within Britain in other district general and private hospitals to measure the extremes of cost of these items. Overall, idarubicin, although more expensive, showed a substantial saving (1477 pounds per patient) in total hospital costs, more than offsetting the increased cost (607 pounds) of the new treatment, an overall savings of 870 pounds per patient (5%).
Approaches modelling cost effectiveness may be an essential part of planning new programmes of treatment in the future. This method can be used to estimate the cost effectiveness of the treatments in different environments and countries where costs may vary widely.
评估急性髓细胞白血病治疗方案的改变可能带来的性价比提升效果。
回顾性分析患者病历以确定管理成本项目；对这些项目进行前瞻性成本核算。利用医学研究委员会急性髓细胞白血病9试验来确定在需要一个或两个疗程诱导治疗以实现完全缓解时这些成本的数额和分布。然后将这些结果外推至四项已发表的国际对照试验，这些试验采用了类似强度的治疗且说明了实现完全缓解所需的治疗疗程数，以比较英国使用伊达比星和柔红霉素联合阿糖胞苷治疗的成本。
伦敦皇家马斯登医院白血病科。
10例接受急性髓细胞白血病强化诱导治疗患者的数据用于确定四大类160项成本：一般（包括住宿）、诊断、支持性治疗和细胞毒性化疗。对一名新治疗患者进行了为期一个月的前瞻性评估，包括时间和动作研究，以核算这些项目的成本；然后评估了医学研究委员会试验中268例接受包括柔红霉素在内的中度诱导化疗患者的成本，并分析了四项比较柔红霉素和伊达比星的国际研究中522例患者的治疗成本。
成本效益以急性髓细胞白血病未治疗患者接受伊达比星或柔红霉素治疗后实现完全缓解的总体成本来衡量。
对160项成本核算项目在改变治疗总成本方面的敏感性进行了测定，这在英国其他地区综合医院和私立医院进行评估以衡量这些项目成本的极端情况。总体而言，伊达比星虽然更昂贵，但在医院总成本上显示出大幅节省（每位患者节省1477英镑），超过抵消新治疗增加的成本（607英镑），每位患者总体节省870英镑（5%）。
成本效益建模方法可能是未来规划新治疗方案的重要组成部分。该方法可用于估计不同环境和成本差异可能很大的国家中治疗的成本效益。
