Kovacevic Aleksandra, Dragojevic-Simic Viktorija, Tarabar Dino, Rancic Nemanja, Jacimovic Nemanja, Katic Jelena, Dagovic Aleksandar, Jakovljevic Mihajlo
Centre for Clinical Pharmacology, Military Medical Academy Medical Faculty, University of Defense, Belgrade, Serbia, Europe.
Expert Rev Anticancer Ther. 2015;15(8):963-70. doi: 10.1586/14737140.2015.1059280. Epub 2015 Jun 18.
To evaluate the costs and survival estimates of metastatic colorectal carcinoma patients treated with conventional cytostatic protocols and adjuvant monoclonal antibodies (mAbs).
Retrospective randomized case series and cost-of-illness analysis was used. Metastatic colorectal carcinoma cases (62) were randomly selected from the archive of the largest university military hospital in Southeastern Europe.
A 6-month longer survival was attributed to mAbs (p = 0.581). Conventional protocols incurred € 5137 (95% CI: € 3758-€ 6517) versus € 22,113 (95% CI: € 16,201-€ 28,025) total direct medical costs in mAb-based group. ICER of € 32,108 per life year gained attributable to mAbs three-fold exceeded informal willingness to pay threshold of Serbia.
mAbs adjuvant protocols had modest positive impact on 5-year survival rates. Costs were driven by targeted biologicals, but significantly higher costs of care were recorded in mAb-treated group in other domains, as well. More selective prescription and reimbursement criteria should be applied to increase cost-effectiveness of targeted oncology agents.
评估采用传统细胞毒性方案和辅助单克隆抗体（mAb）治疗的转移性结直肠癌患者的成本和生存估计。
采用回顾性随机病例系列和疾病成本分析。从东南欧最大的大学军事医院档案中随机选取62例转移性结直肠癌病例。
mAb使生存期延长6个月（p = 0.581）。传统方案的总直接医疗成本为5137欧元（95%CI：3758欧元 - 6517欧元），而基于mAb的治疗组为22113欧元（95%CI：16201欧元 - 28025欧元）。mAb每延长一年生命的增量成本效果比为32108欧元，是塞尔维亚非正式支付意愿阈值的三倍。
mAb辅助方案对5年生存率有适度的积极影响。成本由靶向生物制剂驱动，但在其他方面，mAb治疗组的护理成本也显著更高。应采用更具选择性的处方和报销标准，以提高靶向肿瘤药物的成本效益。
