Department of Drug Policy and Management, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Yakugaku-toshokan 4F, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Int J Clin Oncol. 2010 Jun;15(3):256-62. doi: 10.1007/s10147-010-0045-x. Epub 2010 Mar 4.
The purpose of our study was to estimate the out-of-pocket payment and cost-effectiveness of capecitabine plus oxaliplatin (XELOX) or XELOX plus bevacizumab from the perspective of patients with metastatic colorectal cancer (MCRC).
Based on the NO16966 and NO16967 trials, the mean out-of-pocket payment was calculated from patient-level data. Out-of-pocket payments for 16 cycles (11 months) of first-line chemotherapy and 8 cycles (5 months) of second-line chemotherapy were included. In addition, incremental cost-effectiveness ratios (ICERs) for first-line bevacizumab were calculated by dividing the difference of the out-of-pocket payment by the difference of the mean number of progression-free survival (PFS) years or quality-adjusted PFS (QAPFS) years.
The mean out-of-pocket payments for middle-income patients under 70 years of age were JPY 328,000 for 16 cycles of first-line XELOX and JPY 376,000 for XELOX plus bevacizumab. The mean out-of-pocket payment for 8 cycles of second-line XELOX was calculated to be JPY 175,000. Middle-income patients over 70 years of age were required to pay JPY 61,000 and JPY 72,000 for first-line XELOX and XELOX plus bevacizumab, respectively. The ICERs of middle-income patients <70 years of age were JPY 430,000/PFS-year and JPY 720,000/QAPFS-year, and those of middle-income patients >70 years of age were JPY 100,000/PFS-year and JPY 170,000/QAPFS-year.
We clarified the out-of-pocket payment and cost-effectiveness of chemotherapy of MCRC patients in Japan. Our previous survey shows it is highly possible that many patients prefer to pay that incremental out-of-pocket payment to gain one additional QAPFS year. However, our cost-effectiveness analysis was not conducted from the perspective of society or healthcare payers.
本研究旨在从转移性结直肠癌（MCRC）患者的角度评估卡培他滨联合奥沙利铂（XELOX）或 XELOX 联合贝伐珠单抗的自付费用和成本效益。
基于 NO16966 和 NO16967 试验，从患者水平数据中计算出平均自付费用。包括一线化疗 16 个周期（11 个月）和二线化疗 8 个周期（5 个月）的自付费用。此外，通过将一线贝伐珠单抗的自付费用差值除以无进展生存（PFS）年或质量调整 PFS（QAPFS）年差值，计算出一线贝伐珠单抗的增量成本效益比（ICER）。
对于 70 岁以下的中等收入患者，XELOX 一线治疗 16 个周期的平均自付费用为 328000 日元，XELOX 联合贝伐珠单抗的平均自付费用为 376000 日元。二线 XELOX 8 个周期的平均自付费用计算为 175000 日元。70 岁以上的中等收入患者，XELOX 和 XELOX 联合贝伐珠单抗的一线治疗自付费用分别为 61000 日元和 72000 日元。70 岁以下中等收入患者的 ICER 分别为 430000 日元/PFS 年和 720000 日元/QAPFS 年，70 岁以上中等收入患者的 ICER 分别为 100000 日元/PFS 年和 170000 日元/QAPFS 年。
我们阐明了日本 MCRC 患者化疗的自付费用和成本效益。我们之前的调查表明，许多患者很可能愿意支付额外的自付费用，以获得额外的 QAPFS 年。然而，我们的成本效益分析并非从社会或医疗保健支付方的角度进行。
