Chisaki Yugo, Nakamura Nobuhiko, Yano Yoshitaka
Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University.
Biol Pharm Bull. 2017;40(1):73-81. doi: 10.1248/bpb.b16-00623.
The purpose of this study was to propose a time-series modeling and simulation (M&S) strategy for probabilistic cost-effective analysis in cancer chemotherapy using a Monte-Carlo method based on data available from the literature. The simulation included the cost for chemotherapy, for pharmaceutical care for adverse events (AEs) and other medical costs. As an application example, we describe the analysis for the comparison of four regimens, cisplatin plus irinotecan, carboplatin plus paclitaxel, cisplatin plus gemcitabine (GP), and cisplatin plus vinorelbine, for advanced non-small cell lung cancer. The factors, drug efficacy explained by overall survival or time to treatment failure, frequency and severity of AEs, utility value of AEs to determine QOL, the drugs' and other medical costs in Japan, were included in the model. The simulation was performed and quality adjusted life years (QALY) and incremental cost-effectiveness ratios (ICER) were calculated. An index, percentage of superiority (%SUP) which is the rate of the increased cost vs. QALY-gained plots within the area of positive QALY-gained and also below some threshold values of the ICER, was calculated as functions of threshold values of the ICER. An M&S process was developed, and for the simulation example, the GP regimen was the most cost-effective, in case of threshold values of the ICER=$70000/year, the %SUP for the GP are more than 50%. We developed an M&S process for probabilistic cost-effective analysis, this method would be useful for decision-making in choosing a cancer chemotherapy regimen in terms of pharmacoeconomic.
本研究的目的是基于文献中的可用数据，提出一种使用蒙特卡罗方法进行癌症化疗概率成本效益分析的时间序列建模与仿真（M&S）策略。该仿真包括化疗成本、不良事件（AE）的药学护理成本和其他医疗成本。作为一个应用实例，我们描述了对晚期非小细胞肺癌的四种治疗方案（顺铂加伊立替康、卡铂加紫杉醇、顺铂加吉西他滨（GP）和顺铂加长春瑞滨）进行比较的分析。模型中纳入了以下因素：用总生存期或治疗失败时间解释的药物疗效、AE的频率和严重程度、用于确定生活质量的AE效用值、日本的药物及其他医疗成本。进行了仿真并计算了质量调整生命年（QALY）和增量成本效益比（ICER）。计算了一个指标，即优势百分比（%SUP），它是在获得正QALY的区域内且在ICER的某些阈值以下，成本增加与QALY增加的比值。开发了一个M&S过程，对于仿真示例，在ICER阈值为每年70000美元的情况下，GP方案是最具成本效益的，GP方案的%SUP超过50%。我们开发了一种用于概率成本效益分析的M&S过程，该方法在药物经济学方面对于选择癌症化疗方案的决策将是有用的。
