Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China.
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China; West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China.
Oral Oncol. 2020 Apr;103:104588. doi: 10.1016/j.oraloncology.2020.104588. Epub 2020 Feb 17.
Recently, patients who received induction chemotherapy plus concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma were found to have survival advantages compared with those receiving concurrent chemoradiotherapy alone in two large randomized trials. Based on these two trials, we present a cost-effectiveness analysis to compare gemcitabine and cisplatin (GP) versus cisplatin, fluorouracil, and docetaxel (TPF) for induction chemotherapy to treat locoregionally advanced nasopharyngeal carcinoma.
We constructed a Markov model to compare the cost and effectiveness of GP versus TPF. Clinical data including the frequency of adverse events, recurrence and death obtained from two randomized phase III trials were used to calculate transition probabilities and costs. Health utilities were estimated from the literature. Incremental cost-effectiveness ratios, expressed as dollars per quality-adjusted life-year (QALY), were calculated, and incremental cost-effectiveness ratios less than $27,534.25/QALY (3 × the per capita GDP of China, 2018) were considered cost-effective. One-way sensitivity and probabilistic sensitivity analyses explored the robustness of the model.
Our base case model found that the total cost was $53,082.68 in the GP group and $45,482.66 in the TPF group. The QALYs were 6.82 and 4.11, respectively. The incremental cost-effectiveness ratio favoured the GP regimen, at an incremental cost of $2,804.44 per QALY. The probabilistic sensitivity analysis found that treatment with the GP regimen was cost-effective 100% of the time at a willingness-to-pay threshold of $27,534.25/QALY.
In this model, GP was estimated to be cost-effective compared with cisplatin, fluorouracil, and docetaxel for patients with locoregionally advanced nasopharyngeal carcinoma from the payer's perspectives in the China.
最近，两项大型随机试验发现，接受诱导化疗加同期放化疗的局部晚期鼻咽癌患者的生存优势优于单纯同期放化疗。基于这两项试验，我们进行了一项成本效益分析，比较吉西他滨和顺铂（GP）与顺铂、氟尿嘧啶和多西他赛（TPF）用于局部晚期鼻咽癌诱导化疗的效果。
我们构建了一个马尔可夫模型，比较 GP 与 TPF 的成本和效果。从两项随机 III 期试验中获得的包括不良反应发生率、复发和死亡的临床数据用于计算转移概率和成本。健康效用值从文献中估计。计算增量成本效益比，以每质量调整生命年（QALY）的美元表示，增量成本效益比低于 27534.25 美元/QALY（2018 年中国人均 GDP 的 3 倍）被认为是具有成本效益的。单因素敏感性和概率敏感性分析探索了模型的稳健性。
我们的基础模型发现，GP 组的总费用为 53082.68 美元，TPF 组为 45482.66 美元。QALYs 分别为 6.82 和 4.11。增量成本效益比有利于 GP 方案，增量成本为每 QALY 2804.44 美元。概率敏感性分析发现，在支付意愿阈值为 27534.25 美元/QALY 时，GP 方案治疗的成本效益为 100%。
在这个模型中，从支付者的角度来看，GP 方案被估计为局部晚期鼻咽癌患者具有成本效益，优于顺铂、氟尿嘧啶和多西他赛。
