Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
Pharmacoeconomics. 2010;28(8):629-47. doi: 10.2165/11535560-000000000-00000.
Breast cancer is the leading cancer type diagnosed among women in Western countries. Despite great advances in cancer therapies, many of these patients develop non-curable metastases. The objective of cancer treatment in the metastatic setting is mainly to control symptoms and to prolong survival. The selection of the optimal chemotherapeutic regimen is affected by performance status, tumour biology, site and extent of the disease and the exposure to prior therapies. Recent developments in new kinds of cancer drugs have contributed not only to immense progress in clinical outcomes but also to dramatically increased treatment-related health costs. Cost-effectiveness analysis is a type of economic evaluation that compares costs and health outcomes of alternative intervention strategies in a systematic way. In this review, a systematic literature search was performed and the evidence on the cost effectiveness of conventional chemotherapy and targeted therapy for metastatic breast cancer was explored. Cost-effectiveness/-utility analysis of treatment regimens for metastatic breast cancer were identified using literature and reference searches (MEDLINE). Published reports on conventional and targeted cancer therapies were scrutinized and incremental cost-effectiveness ratios (ICERs) were abstracted. Furthermore, the quality of reporting, as well as methodological and modeling issues, were extensively discussed. From full-text article reviews, six cost-effectiveness analyses on conventional therapies and seven studies on targeted therapies were included. Eight analyses were conducted in European countries, three in the US and two in Canada. The economic models were primarily (69%) based on clinical trial data. Results from sensitivity analyses and study perspectives were reported by all studies. Discount rates were mentioned in five articles (39%). The methods of reporting costs and effects varied considerably, as did trial design across conventional chemotherapies, which made it difficult to compare those analyses. The pharmacoeconomic studies came to different conclusions. The actual clinical evidence does not suggest one conventional chemotherapy regimen as superior. Studies on cytotoxic agents showed mainly favourable cost-effectiveness ratios. Targeted therapies indicated both favourable and non-favourable ratios. Currently, trastuzumab is the only antibody-based targeted therapy that is established in the clinic for the metastatic setting.
在西方国家，乳腺癌是女性中最常见的癌症类型。尽管癌症治疗取得了巨大进展，但许多患者仍会发展为不可治愈的转移癌。转移性癌症治疗的主要目的是控制症状和延长生存期。化疗方案的最佳选择受到身体状况、肿瘤生物学、疾病部位和范围以及既往治疗暴露情况的影响。新型癌症药物的最新进展不仅为临床结果带来了巨大进步，也显著增加了治疗相关的健康成本。成本效益分析是一种经济评估方法，它以系统的方式比较替代干预策略的成本和健康结果。在本综述中，我们进行了系统的文献检索，探讨了转移性乳腺癌常规化疗和靶向治疗的成本效益证据。通过文献和参考文献搜索（MEDLINE）确定转移性乳腺癌治疗方案的成本效益/效用分析。仔细审查了关于常规和靶向癌症治疗的已发表报告，并提取了增量成本效益比（ICER）。此外，还广泛讨论了报告质量以及方法学和建模问题。从全文文章综述中，纳入了 6 项常规治疗的成本效益分析和 7 项靶向治疗的研究。8 项分析在欧洲国家进行，3 项在美国进行，2 项在加拿大进行。经济模型主要（69%）基于临床试验数据。所有研究均报告了敏感性分析和研究角度的结果。有 5 篇文章（39%）提到了贴现率。报告成本和效果的方法差异很大，常规化疗的试验设计也不同，这使得难以比较这些分析。药物经济学研究得出了不同的结论。实际临床证据并未表明一种常规化疗方案具有优势。细胞毒性药物的研究主要显示出有利的成本效益比。靶向治疗则显示出有利和不利的比值。目前，曲妥珠单抗是唯一在转移性乳腺癌治疗中确立的基于抗体的靶向治疗药物。
