Song Hyun Jin, Lee Eui-Kyung, Lee Jun Ah, Kim Hye-Lin, Jang Kyoung Won
School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 440-746, Republic of Korea.
Tumour Biol. 2014 Sep;35(9):8771-9. doi: 10.1007/s13277-014-2139-y. Epub 2014 May 30.
In the absence of long-term clinical trials that compare mifamurtide plus chemotherapy versus chemotherapy only for treatment of osteosarcoma, decision analysis is a useful tool that helps to determine the optimal treatment strategy. We analyzed the differences between mifamurtide plus chemotherapy versus chemotherapy only by using modeling to determine the treatment approach that results in longer life expectancy among children with osteosarcoma. We used the Markov model to compare the expected lifetime quality-adjusted life years (QALYs) between mifamurtide plus chemotherapy versus chemotherapy only. Our target cohort consisted of children with osteosarcoma. The starting age of the cohort was 12 years and cycle length was 3 months. The transition probabilities for each disease state and death were calculated using overall survival or progression free survival data from randomized controlled trials. Utility weights from scenario-based survey for 303 Korean general populations were applied to the model. Based on the base case analysis, the incremental benefit analysis indicated that mifamurtide plus chemotherapy resulted in an incremental QALY increase of 1.57 (a relative increase of 16.3 % in QALY expectancy) compared to chemotherapy only. Also, the incremental life years gained (LYG) from mifamurtide plus chemotherapy was 1.96 on comparison with chemotherapy only; this is a relative increase of 15.7 % in LYG expectancy. The decision analysis model indicated that mifamurtide plus chemotherapy was associated with a substantially longer survival than chemotherapy only among children with osteosarcoma during their lifetime.
在缺乏比较米法穆肽联合化疗与单纯化疗治疗骨肉瘤的长期临床试验的情况下，决策分析是一种有助于确定最佳治疗策略的有用工具。我们通过建模分析了米法穆肽联合化疗与单纯化疗之间的差异，以确定能使骨肉瘤患儿预期寿命更长的治疗方法。我们使用马尔可夫模型比较米法穆肽联合化疗与单纯化疗的预期终身质量调整生命年（QALY）。我们的目标队列由骨肉瘤患儿组成。队列起始年龄为12岁，周期长度为3个月。使用随机对照试验的总生存或无进展生存数据计算每种疾病状态和死亡的转移概率。来自303名韩国普通人群的基于情景调查的效用权重应用于该模型。基于基础病例分析，增量效益分析表明，与单纯化疗相比，米法穆肽联合化疗导致QALY增量增加1.57（QALY预期相对增加16.3%）。此外，与单纯化疗相比，米法穆肽联合化疗获得的增量生命年（LYG）为1.96；这是LYG预期相对增加15.7%。决策分析模型表明，在骨肉瘤患儿的一生中，米法穆肽联合化疗比单纯化疗的生存期显著更长。
