Department of Pharmacology and Therapy, Faculty of Medicine Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia.
Department of Pharmaceutics, Faculty of Pharmacy, Gadjah Mada University, Yogyakarta, Indonesia.
Asian Pac J Cancer Prev. 2021 Jun 1;22(6):1921-1926. doi: 10.31557/APJCP.2021.22.6.1921.
Since 2016, bevacizumab has been widely used to treat metastatic colorectal cancer (mCRC) in Indonesia. Nevertheless, the high cost of bevacizumab has raised the question of whether the therapy is considered cost-effective and should be included in the national health insurance system. This study aimed to assess the cost-effectiveness of bevacizumab plus chemotherapy versus chemotherapy alone for the treatment of mCRC patients.
A Markov model was applied using the perspective of the Indonesian healthcare system to assess cost-effectiveness. The health outcomes were expressed in terms of quality-adjusted life years (QALY) using the validated EuroQoL-5D-5L instrument. Data for medical costs were collected from hospital billings in four hospitals located in three different cities in Indonesia. Meanwhile, data for utility were obtained from interviewing 90 patients who came to the hospital. We compared those mCRC patients who received chemotherapy alone either with FOLFOX or FOLFIRI, versus patients who received the addition of bevacizumab.
With the perspective of societal, the incremental cost-effectiveness ratio (ICER) of adding bevacizumab was USD 49,312 per QALY gained using secondary data and USD 28,446 per QALY using real world data.
Using either a healthcare or societal perspective, the addition of bevacizumab for mCRC treatment was considered not cost-effective.
自 2016 年以来，贝伐珠单抗已被广泛用于治疗印度尼西亚转移性结直肠癌（mCRC）。然而，贝伐珠单抗的高昂价格引发了一个问题，即该疗法是否具有成本效益，是否应纳入国家健康保险体系。本研究旨在评估贝伐珠单抗联合化疗与单纯化疗治疗 mCRC 患者的成本效益。
采用 Markov 模型，从印度尼西亚医疗保健系统的角度评估成本效益。使用经过验证的 EuroQoL-5D-5L 工具，健康结果以质量调整生命年（QALY）表示。医疗费用数据来自印度尼西亚四个城市的四家医院的住院费用。同时，使用效用数据通过访谈 90 名来医院的患者获得。我们将接受单独化疗（FOLFOX 或 FOLFIRI）的 mCRC 患者与接受贝伐珠单抗联合治疗的患者进行比较。
从社会角度来看，使用二级数据，添加贝伐珠单抗的增量成本效益比（ICER）为每获得一个 QALY 增加 49312 美元，使用真实世界数据则为每获得一个 QALY 增加 28446 美元。
无论从医疗保健还是社会角度来看，贝伐珠单抗治疗 mCRC 的附加治疗均不具有成本效益。
