Xuan J W, Zhang Z Y, Wang Y F, Mao Z G, Lu Y J, Wang R Z
Health Economic Research Institute, Sun Yat-sen University, Guangzhou 510085, China.
Department of Endocrinology, Huashan Hospital of Fudan University, Shanghai 200040, China.
Zhonghua Yi Xue Za Zhi. 2017 Mar 14;97(10):765-769. doi: 10.3760/cma.j.issn.0376-2491.2017.10.010.
To evaluate the cost-effectiveness of octreotide long acting release (LAR) vs lanreotide slow release (SR) for the treatment of postoperative acromegalic patients with elevated levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in China. A decision tree model was constructed and the treatment impact was projected for one year in Chinese setting. The clinical efficacy measure used was the percentage of patients achieving normalization (control) of either IGF-1 or GH levels. Efficacy of octreotide LAR and lanreotide SR, incidence of comorbidities, impact of acromegaly on health-related quality of life, and drug-related side effects data were obtained from literature. The cost of medication was collected through a chart review from five hospitals in five cities of China. Clinical experts from these hospitals were requested to complete a questionnaire to document the utilization of medical resources, costs of comorbidities, side effects as well as cost of administration. One-way sensitivity analysis was performed to evaluate the robustness of the results. Compared to lanreotied SR group, the percentage of patients achieving normalization of IGF-1 and GH levels of octreotide LAR group were 10% and 9% higher, respectively. When either IGF-1 or GH control were used as the efficacy measure, patients in the octreotide LAR group exhibit less comorbidities and need less continued treatment with a second operation and radiotherapy than those in lanreotide SR group. When IGF-1 was used as efficacy measure, octreotide LAR not only achieved better efficacy but resulted in overall cost-saving, with a total cost savings of ￥ 3 792 per patient for one year, which demonstrated that octreotide LAR was a dominant cost-saving strategy. When GH control was used as the efficacy measure, octreotide LAR achieved a better overall clinical efficacy with a slightly higher total costs (￥ 4 121 higher per patient per year). Sensitivity analysis didn't change the conclusion that octreotide LAR remains dominant over lanreotide SR, indicating the robustness of this model. Octreotide LAR achieved better overall biochemical control compared with lanreotide SR which result in less comorbidity rate, second operation and radiotherapy as well as related costs.
评估在中国，长效奥曲肽（LAR）与缓释兰瑞肽（SR）治疗生长激素（GH）和胰岛素样生长因子1（IGF-1）水平升高的肢端肥大症术后患者的成本效益。构建了一个决策树模型，并对中国背景下一年的治疗效果进行了预测。使用的临床疗效指标是IGF-1或GH水平达到正常化（对照）的患者百分比。奥曲肽LAR和兰瑞肽SR的疗效、合并症发生率、肢端肥大症对健康相关生活质量的影响以及药物相关副作用数据均来自文献。通过对中国五个城市五家医院的病历审查收集药物成本。要求这些医院的临床专家填写一份问卷，以记录医疗资源的使用情况、合并症成本、副作用以及给药成本。进行单向敏感性分析以评估结果的稳健性。与兰瑞肽SR组相比，奥曲肽LAR组IGF-1和GH水平达到正常化的患者百分比分别高10%和9%。当以IGF-1或GH控制作为疗效指标时，奥曲肽LAR组患者的合并症较少，与兰瑞肽SR组相比，二次手术和放疗的持续治疗需求较少。当以IGF-1作为疗效指标时，奥曲肽LAR不仅疗效更好，而且总体成本节约，每位患者每年总成本节约3792元，这表明奥曲肽LAR是一种占优的成本节约策略。当以GH控制作为疗效指标时，奥曲肽LAR总体临床疗效更好，但总成本略高（每位患者每年高4121元）。敏感性分析并未改变奥曲肽LAR优于兰瑞肽SR的结论，表明该模型的稳健性。与兰瑞肽SR相比，奥曲肽LAR实现了更好的总体生化控制，导致合并症发生率、二次手术和放疗以及相关成本更低。
