WG Consulting, High Wycombe, UK.
Value Health. 2013 Jun;16(4):507-16. doi: 10.1016/j.jval.2013.01.011. Epub 2013 May 9.
To estimate the cost-effectiveness of trabectedin plus pegylated liposomal doxorubicin (PLD) compared with PLD alone for the treatment of patients with relapsed platinum-sensitive ovarian cancer who are not expected to benefit from retreatment with platinum-based therapies based on the final survival data published in October 2012.
A decision-analytic model estimated the cost per quality-adjusted life-year (QALY) gained for trabectedin plus PLD compared with PLD alone from the UK National Health Service and Personal Social Services perspective over a lifetime horizon. Mean progression-free survival and overall survival were calculated by using parametric survival distributions adjusted for imbalances discovered in the final survival data. Between-arm imbalances included the platinum-free interval, cancer antigen 125 (CA-125), and Eastern Cooperative Oncology Group performance score. Cost categories included drug, administration, medical management, and treatment of adverse events. Quality of life was measured by using the EuroQol five-dimensional questionnaire. Uncertainty was addressed by deterministic and probabilistic sensitivity analysis.
Over a lifetime horizon, trabectedin plus PLD increased mean progression-free survival by 3.0 months and overall survival by 9.7 months compared with PLD alone. The additional cost and QALYs of trabectedin plus PLD were £18,476 and 0.49, resulting in an incremental cost-effectiveness ratio of £38,026 per QALY. Sensitivity analyses showed that results were sensitive to platinum-free interval adjustment and the choice of survival distributions.
The analysis estimated a significant improvement in mean overall survival and incremental cost per QALY compared with that calculated in the original National Institute for Health and Clinical Excellence assessment, which was based on immature survival data.
根据 2012 年 10 月公布的最终生存数据，评估盐酸多柔比星脂质体与盐酸多柔比星脂质体联合博来霉素用于治疗无铂类化疗获益预期的复发性铂类敏感卵巢癌患者的成本效果。
采用决策分析模型，从英国国家医疗服务体系和个人社会服务角度，对多柔比星脂质体联合博来霉素与多柔比星脂质体单药治疗的终生成本效果进行分析。使用经最终生存数据中发现的不平衡调整后的参数生存分布，计算无进展生存期和总生存期的平均值。组间的不平衡因素包括铂类药物的无进展间期、癌抗原 125（CA-125）和东部肿瘤协作组的体能状况评分。成本类别包括药物、给药、医疗管理和不良事件的治疗。使用欧洲五维健康量表来衡量生活质量。通过确定性和概率敏感性分析来解决不确定性。
在终生时间范围内，与多柔比星脂质体单药治疗相比，多柔比星脂质体联合博来霉素治疗可使平均无进展生存期延长 3.0 个月，总生存期延长 9.7 个月。多柔比星脂质体联合博来霉素的额外成本和 QALYs 分别为 18476 英镑和 0.49，增量成本效果比为 38026 英镑/QALY。敏感性分析表明，结果对铂类药物无进展间期的调整和生存分布的选择较为敏感。
与基于不成熟生存数据的英国国家卫生与临床优化研究所最初评估相比，该分析估计在总生存平均值和增量成本每 QALY 方面有显著改善。
