Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Cancer Med. 2021 Feb;10(3):1027-1033. doi: 10.1002/cam4.3690. Epub 2020 Dec 30.
Home-based chemotherapy (HC) is a new treatment alternative to hospital-based chemotherapy treatment (IP) and is administered via portable intravenous pumps at the patient's home. HC reduces the demand for inpatient bed capacity in hospitals and reduces the cost of an infusion. This study takes a societal perspective while conducting the cost-utility and budget impact analyses (BIA) of HC and IP with an mFOLFOX6 regimen on patients with stage III colon cancer. We conducted a cost-utility analysis with a 6-month time horizon. The parameter inputs for the model were gathered from a retrospective cohort study on patients diagnosed with stage III colon cancer at Ramathibodi Hospital, Bangkok. The resource usage of HC and IP was determined based on medical records. The per-unit direct medical, home health service, and adverse events (AE) management costs were gathered from the standard cost list. The health outcome of treatment was measured in terms of quality-adjusted life years. Disutility related to AE was calculated. We conducted a sensitivity analysis for the uncertainty results and performed BIA based on the societal perspective on a 1-year time horizon. HC provided a cost-saving of $1,513.37 per patient for the period of treatment. Thus, assuming 526 patients per year, the use of HC could achieve a cumulative annual cost-saving of $828,436. HC is a cost-saving strategy compared to IP for stage III colon cancer treatment. We recommend that the service reimbursement should include national standardization in chemotherapy regimens as well as practice guidelines and protocols to prevent serious AEs.
家庭化疗(HC)是一种新的治疗选择,可替代基于医院的化疗治疗(IP),并通过便携式静脉输液泵在患者家中进行。HC 减少了医院对住院床位的需求,并降低了输液成本。本研究从社会角度出发,对采用 mFOLFOX6 方案治疗 III 期结肠癌的 HC 和 IP 进行了成本效用和预算影响分析(BIA)。我们进行了一项具有 6 个月时间范围的成本效用分析。模型的参数输入来自曼谷 Ramathibodi 医院诊断为 III 期结肠癌的回顾性队列研究。根据医疗记录确定 HC 和 IP 的资源使用情况。单位直接医疗、家庭保健服务和不良事件(AE)管理成本从标准成本清单中收集。治疗的健康结果以质量调整生命年来衡量。计算了与 AE 相关的不舒适。我们对不确定性结果进行了敏感性分析,并基于社会角度在 1 年时间范围内进行了 BIA。HC 在治疗期间为每位患者节省了 1513.37 美元的成本。因此,假设每年有 526 名患者,使用 HC 可以实现每年 828436 美元的累计成本节省。HC 是 III 期结肠癌治疗的一种比 IP 更具成本效益的策略。我们建议,服务报销应包括化疗方案的国家标准以及实践指南和协议,以预防严重 AE。
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