西班牙高危骨髓增生异常综合征患者使用阿扎胞苷治疗的成本效果分析。
Cost-effectiveness analysis of azacitidine in the treatment of high-risk myelodysplastic syndromes in Spain.
机构信息
Statistic Department, University of Barcelona, C/Diagonal 643, Barcelona 08028, Spain.
出版信息
Health Econ Rev. 2013 Dec 5;3(1):28. doi: 10.1186/2191-1991-3-28.
BACKGROUND
The objective of the study was to analyse whether azacitidine is a cost-effective option for the treatment of myelodysplastic syndrome in the Spanish setting compared with conventional care regimens, including best supportive care, low dose chemotherapy and standard dose chemotherapy.
METHODS
A life-time Markov model was constructed to evaluate the cost-effectiveness of azacitidine compared with conventional care regimens. The health states modelled were: myelodysplastic syndrome, acute myeloid leukemia and death. Variables measured included survival rates, progression probabilities and quality of life indicators. Resource use and cost data reflect the Spanish context. The analysis was performed from the Spanish National Health System perspective, discounting both costs (in 2012 euros) and future effects at 3%. The time horizon considered was end-of-life. Results were expressed in cost per quality-adjusted life-year gained and cost per life-year gained and compared with cost-effectiveness thresholds.
RESULTS
According to the current use of each conventional care regimens options in Spain, azacitidine resulted in €34,673 per quality-adjusted life-year gained (€28,891 per life-year gained) with an increase of 1.89 in quality-adjusted life-years (2.26 in life-years). Azacitidine was superior to best supportive care and low dose chemotherapy in terms of quality-adjusted life-years gained, 1.82 and 2.03, respectively (life-years 2.16 vs. best supportive care, 2.39 vs. low dose chemotherapy). Treatment with azacitidine resulted in longer survival time and thus longer treatment time and lifetime costs. The incremental cost-effectiveness ratio was €39,610 per quality-adjusted life-year gained vs. best supportive care and €30,531 per quality-adjusted life-year gained vs. low dose chemotherapy (€33,111 per life-year gained vs. best supportive care and €25,953 per life-year gained vs. low dose chemotherapy).
CONCLUSIONS
The analysis showed that the use of azacitidine in the treatment of high-risk myelodysplastic syndrome is a cost-effective option compared with conventional care regimen options used in the Spanish setting and had an incremental cost-effectiveness ratio within the range of the thresholds accepted by health authorities.
背景
本研究旨在分析在西班牙，与包括最佳支持治疗、低剂量化疗和标准剂量化疗在内的常规治疗方案相比，阿扎胞苷治疗骨髓增生异常综合征是否具有成本效益。
方法
构建了一个生命周期马尔可夫模型，以评估与常规治疗方案相比，阿扎胞苷的成本效益。模型中的健康状态包括骨髓增生异常综合征、急性髓系白血病和死亡。测量的变量包括生存率、进展概率和生活质量指标。资源使用和成本数据反映了西班牙的情况。该分析从西班牙国家卫生系统的角度进行，对成本（2012 年欧元）和未来影响（3%）进行贴现。考虑的时间范围是生命终末期。结果以每获得一个质量调整生命年的成本和每获得一个生命年的成本表示，并与成本效益阈值进行比较。
结果
根据西班牙目前每种常规治疗方案的使用情况，阿扎胞苷的每获得一个质量调整生命年的成本为 34673 欧元（每获得一个生命年的成本为 28891 欧元），质量调整生命年增加了 1.89 年（生命年增加了 2.26 年）。与最佳支持治疗和低剂量化疗相比，阿扎胞苷在获得质量调整生命年方面具有优势，分别为 1.82 和 2.03（生命年分别为 2.16 比最佳支持治疗，2.39 比低剂量化疗）。阿扎胞苷治疗可延长生存时间，从而延长治疗时间和终身成本。增量成本效益比为与最佳支持治疗相比每获得一个质量调整生命年的成本为 39610 欧元，与低剂量化疗相比每获得一个质量调整生命年的成本为 30531 欧元（与最佳支持治疗相比每获得一个生命年的成本为 33111 欧元，与低剂量化疗相比每获得一个生命年的成本为 25953 欧元）。
结论
分析表明，与西班牙常规治疗方案相比，在治疗高危骨髓增生异常综合征时使用阿扎胞苷是一种具有成本效益的选择，其增量成本效益比在卫生当局可接受的范围内。
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