Du Qiong, Zhai Qing, Zhu Bin, Xu Xiao-Le, Yu Bo
1 Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China.
2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Oncol Pharm Pract. 2017 Sep;23(6):403-412. doi: 10.1177/1078155216652212. Epub 2016 Jun 3.
Background Two pivotal Phase III trials compared the efficacy of palonosetron, ondansetron and granisetron, combined with dexamethasone, for the prevention of nausea and vomiting following highly emetogenic chemotherapy. However, an economic evaluation of these three regimens in the real-world setting of Chinese adult patients has not been determined. Objectives To estimate, from the perspective of the Chinese healthcare system, which of these frequently used strategies consisting of 0.25 mg palonosetron (0.25P), 16 mg ondansetron (Onda), and 3 mg granisetron (Gran), is the most cost-effective option in patients following highly emetogenic chemotherapy. Methods A Markov decision-analytic model was developed. The health and economic outcomes of the three strategies; 0.25P, Onda, and Gran were investigated. The clinical and utility data were taken from published studies. The cost data were calculated according to current local Chinese practices. Sensitivity analyses were performed to determine the impact of uncertainty regarding the results. Results The base-case analysis showed that the 0.25P strategy yielded maximum health benefits compared with the other two strategies. However, the probabilistic sensitivity analysis demonstrated that the Gran strategy was the most cost-effective approach when the willingness-to-pay threshold was not more than US$22,515/quality-adjusted life year. Moreover, palonosetron is not cost-effective in preventing 'overall' nausea and vomiting following highly emetogenic chemotherapy in Chinese patients. Conclusions Our analysis suggests that, compared with palonosetron and ondansetron, 3 mg granisetron may be a cost-effective treatment option in the current Chinese healthcare setting.
两项关键的III期试验比较了帕洛诺司琼、昂丹司琼和格拉司琼联合地塞米松预防高度致吐性化疗后恶心和呕吐的疗效。然而，尚未对这三种方案在中国成年患者实际临床环境中的经济性进行评估。目的：从中国医疗保健系统的角度估计，在接受高度致吐性化疗的患者中，由0.25毫克帕洛诺司琼（0.25P）、16毫克昂丹司琼（Onda）和3毫克格拉司琼（Gran）组成的这些常用策略中，哪一种是最具成本效益的选择。方法：建立马尔可夫决策分析模型。研究了三种策略（0.25P、Onda和Gran）的健康和经济结果。临床和效用数据取自已发表的研究。成本数据根据中国当地现行做法计算。进行敏感性分析以确定结果不确定性的影响。结果：基础病例分析表明，与其他两种策略相比，0.25P策略产生了最大的健康效益。然而，概率敏感性分析表明，当支付意愿阈值不超过22,515美元/质量调整生命年时，Gran策略是最具成本效益的方法。此外，在中国患者中，帕洛诺司琼在预防高度致吐性化疗后的“总体”恶心和呕吐方面不具有成本效益。结论：我们的分析表明，与帕洛诺司琼和昂丹司琼相比，3毫克格拉司琼在当前中国医疗环境中可能是一种具有成本效益的治疗选择。
