Du Jeng-Shiun, Kuo Yi-Chun, Shi Hon-Yi, Wang Ming-Chung, Wang Li-Ying, Chuang Tzer-Ming, Ke Ya-Lun, Yeh Tsung-Jang, Gau Yu-Ching, Wang Hui-Ching, Cho Shih-Feng, Hsiao Samuel Yien, Liu Yi-Chang, Hsu Chin-Mu, Hsiao Hui-Hua
Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
J Pers Med. 2022 Jan 19;12(2):130. doi: 10.3390/jpm12020130.
This study aimed to evaluate the cost-effectiveness of treating transplant-ineligible myeloma patients with either a bortezomib plus thalidomide plus dexamethasone (VTD) or a bortezomib plus melphalan plus prednisolone (VMP) treatment in Taiwan.
Newly diagnosed, transplant-ineligible myeloma patients with VTD or VMP therapy were enrolled from two medical centers in southern Taiwan. Quality-adjusted life years (QALYs) were used as the measurement unit of the effectiveness evaluation, and the incremental cost-effectiveness ratio (ICER) was used for comparison between the two groups. A net monetary benefit approach and cost-effectiveness acceptability curve were also used for the cost-effectiveness assessment. A one-way sensitivity analysis was used to check the impact of different parameters. In total, 77 patients were enrolled in the study with 43 patients in the VTD group and 34 patients in the VMP group. Clinical presentations were similar without significant difference, except the VTD group had a higher survival rate ( = 0.029). Comparisons of the two groups over an eight-month time horizon revealed a significant lower mean of direct medical costs in the VTD group than in the VMP group ( < 0.001), and a significantly higher average QALY was gained ( < 0.001).
The study demonstrated the greater clinical benefit and cost-effectiveness of VTD compared to VMP therapy in transplant-ineligible, newly diagnosed myeloma patients.
本研究旨在评估在台湾，使用硼替佐米联合沙利度胺及地塞米松（VTD）或硼替佐米联合美法仑及泼尼松龙（VMP）治疗不符合移植条件的骨髓瘤患者的成本效益。
从台湾南部的两个医疗中心招募新诊断的、不符合移植条件且接受VTD或VMP治疗的骨髓瘤患者。质量调整生命年（QALYs）用作疗效评估的测量单位，增量成本效益比（ICER）用于两组之间的比较。还采用净货币效益方法和成本效益可接受性曲线进行成本效益评估。采用单向敏感性分析来检验不同参数的影响。本研究共纳入77例患者，其中VTD组43例，VMP组34例。除VTD组生存率较高外（P = 0.029），两组临床表现相似，无显著差异。两组在八个月时间范围内的比较显示，VTD组的直接医疗成本均值显著低于VMP组（P < 0.001），且获得的平均QALY显著更高（P < 0.001）。
该研究表明，对于新诊断的、不符合移植条件的骨髓瘤患者，与VMP治疗相比，VTD治疗具有更大的临床益处和成本效益。
