Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Nuclear Medcine/PET Image Center, Second Xiangya Hospital, Changsha, Hunan, China.
BMJ Open. 2022 Nov 14;12(11):e060983. doi: 10.1136/bmjopen-2022-060983.
The perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin plus docetaxel (FLOT) was recommended by the Chinese Society of Clinical Oncology Guidelines for gastric cancer (2018 edition) for patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (class IIA). However, the economic impact of FLOT chemotherapy in China remains unclear. The analysis aimed to compare the cost-effectiveness of FLOT versus epirubicin, cisplatin plus fluorouracil or capecitabine (ECF/ECX) in patients with locally advanced resectable tumours.
We developed a Markov model to compare the healthcare and economic outcomes of FLOT and ECF/ECX in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma. Costs were estimated from the perspective of Chinese healthcare system. Clinical and utility inputs were derived from the FLOT4 phase II/III clinical trial and published literature. Sensitivity analyses were employed to assess the robustness of our result. The annual discount rate for costs and health outcomes was set at 5%.
The primary outcome of incremental cost-effectiveness ratios (ICERs) was calculated as the cost per quality-adjusted life years (QALYs).
The base-case analysis found that compared with ECF/ECX, the use of FLOT chemotherapy was associated with an additional 1.08 QALYs, resulting in an ICER of US$851/QALY. One-way sensitivity analysis results suggested that the HR of overall survival and progression-free survival had the greatest impact on the ICER. Probabilistic sensitivity analysis demonstrated that FLOT was more likely to be cost-effective compared with ECF/ECX at a willingness-to-pay threshold of US$31 513/QALY.
For patients with locally advanced resectable tumours, the FLOT chemotherapy is a cost-effective treatment option compared with ECF/ECX in China.
NCT01216644.
中国临床肿瘤学会（CSCO）胃癌诊疗指南（2018 年版）推荐氟尿嘧啶、亚叶酸钙、奥沙利铂联合多西他赛（FLOT）方案用于可切除胃或胃食管结合部腺癌患者的围手术期化疗（ⅡA 类）。然而，FLOT 化疗在中国的经济影响尚不清楚。本分析旨在比较 FLOT 与表柔比星、顺铂联合氟尿嘧啶或卡培他滨（ECF/ECX）在局部晚期可切除肿瘤患者中的成本效果。
我们开发了一个 Markov 模型来比较 FLOT 和 ECF/ECX 在可切除胃或胃食管结合部腺癌患者中的医疗保健和经济结果。成本是从中国医疗保健系统的角度来估算的。临床和实用投入来自于 FLOT4 期 II/III 期临床试验和已发表的文献。采用敏感性分析来评估我们结果的稳健性。成本和健康结果的年贴现率设定为 5%。
增量成本效果比（ICER）作为每质量调整生命年（QALY）的成本来计算。主要结果。基于病例分析发现，与 ECF/ECX 相比，使用 FLOT 化疗可额外获得 1.08 个 QALYs，导致 ICER 为 851 美元/QALY。单因素敏感性分析结果表明，总生存和无进展生存的 HR 对 ICER 影响最大。概率敏感性分析表明，与 ECF/ECX 相比，FLOT 在 31513 美元/QALY 的意愿支付阈值下更有可能具有成本效果。
对于局部晚期可切除肿瘤患者，FLOT 化疗是一种比 ECF/ECX 更具成本效益的治疗选择。
NCT01216644。
