Andronis Lazaros, Goranitis Ilias, Pirrie Sarah, Pope Ann, Barton Darren, Collins Stuart, Daunton Adam, McLaren Duncan, O'Sullivan Joe M, Parker Chris, Porfiri Emilio, Staffurth John, Stanley Andrew, Wylie James, Beesley Sharon, Birtle Alison, Brown Janet E, Chakraborti Prabir, Hussain Syed A, Russell J Martin, Billingham Lucinda J, James Nicholas D
Health Economics Unit, University of Birmingham, Birmingham, UK.
Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK.
BJU Int. 2017 Apr;119(4):522-529. doi: 10.1111/bju.13549. Epub 2016 Jul 10.
To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC).
Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves.
The per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively.
The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.
评估在去势抵抗性前列腺癌（CRPC）患者的标准多西他赛化疗基础上加用唑来膦酸或锶-89的成本效益。
利用在TRAPEZE 2×2析因随机试验（ISRCTN 12808747）中前瞻性收集的707例患者的资源使用和生活质量数据，评估以下两种情况的成本效益：i）唑来膦酸与不使用唑来膦酸（ZA组与非ZA组）；ii）锶-89与不使用锶-89（Sr89组与非Sr89组）。成本从英国国家医疗服务体系的角度进行估算，包括试验治疗、伴随用药以及相关医院和初级医疗服务使用的支出。根据患者对评估健康状况的通用欧洲五维健康量表EQ-5D-3L的回答计算质量调整生命年（QALY）。结果以增量成本效益比（ICER）和成本效益可接受性曲线表示。
ZA组每位患者的成本为12667英镑，比非ZA组的等效成本高251英镑。ZA组患者的QALY平均比非ZA组患者多0.03。该比较的ICER为8005英镑。Sr89的成本为13230英镑，比非Sr89组高1365英镑，与非Sr89组相比QALY增加了0.08。Sr89的ICER为16884英镑。ZA和Sr89具有成本效益的概率分别为0.64和0.60。
在标准化疗基础上加用骨靶向治疗可使QALY有小幅改善，成本适度增加（或节省成本）。ZA和Sr89的ICER低于传统的每QALY支付意愿阈值，表明在化疗基础上加用它们可能是一种具有成本效益的资源利用方式。
