医疗保健覆盖范围影响泰国肺癌患者的生存率。
Healthcare coverage affects survival of Thai lung cancer patients.
作者信息
Khiewngam Khantong, Oranratnachai Songporn, Kamprerasart Kaettipong, Kunakorntham Patratorn, Sanvarinda Pimtip, Trachu Narumol, Pimsa Pongput, Wiwitkeyoonwong Jirapath, Thamrongjirapat Thanaporn, Dejthevaporn Thitiya, Sirachainan Ekaphop, Reungwetwattana Thanyanan
机构信息
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Medical Oncology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Front Oncol. 2023 Feb 21;13:1047644. doi: 10.3389/fonc.2023.1047644. eCollection 2023.
BACKGROUND
Despite significant benefits of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatment in patients with -mutated NSCLC, access remains limited in Thailand and elsewhere.
METHODS
Retrospective analysis of patients with locally advanced/recurrent NSCLC and known mutation (m) status treated at Ramathibodi Hospital (2012-2017). Prognostic factors for overall survival (OS), including treatment type and healthcare coverage, were analyzed using Cox regression.
RESULTS
Of 750 patients, 56.3% were m-positive. After first-line therapy (n=646), 29.4% received no subsequent (second-line) treatment. EGFR-TKI-treated m-positive patients survived significantly longer than m-negative patients without EGFR-TKIs (median OS [mOS] 36.4 vs. 11.9 months; hazard ratio HR=0.38 [95%CI 0.32-0.46], <0.001). Cox regression indicated significantly longer OS in patients with comprehensive healthcare coverage that included reimbursement of EGFR-TKIs, versus basic coverage (mOS 27.2 vs. 18.3 months; adjusted HR=0.73 [95%CI 0.59-0.90]). Compared with best supportive care (BSC; reference), EGFR-TKI-treated patients survived significantly longer (mOS 36.5 months; adjusted HR (aHR)=0.26 [95%CI 0.19-0.34]), and versus chemotherapy alone (14.5 months; aHR=0.60 [95%CI 0.47-0.78]). In m-positive patients (n=422), relative survival benefit of EGFR-TKI treatment remained highly significant (aHR[EGFR-TKI]=0.19 [95%CI 0.12-0.29]; aHR(chemotherapy only)=0.50 [95%CI 0.30-0.85]; reference:BSC), indicating that healthcare coverage (reimbursement) affected treatment choice and survival.
CONCLUSION
Our analysis describes m prevalence and survival benefit of EGFR-TKI therapy for m-positive NSCLC patients treated from 2012-2017, one of the largest such Thai datasets. Together with research by others, these findings contributed evidence supporting the decision to broaden erlotinib access on healthcare schemes in Thailand from 2021, demonstrating the value of local real-world outcome data for healthcare policy decision-making.
背景
尽管表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗对携带特定突变的非小细胞肺癌（NSCLC）患者有显著益处，但在泰国及其他地区，其可及性仍然有限。
方法
对拉玛蒂博迪医院（2012 - 2017年）收治的局部晚期/复发性NSCLC且已知特定突变（m）状态的患者进行回顾性分析。使用Cox回归分析总生存（OS）的预后因素，包括治疗类型和医疗保障覆盖情况。
结果
750例患者中，56.3%为m阳性。一线治疗后（n = 646），29.4%的患者未接受后续（二线）治疗。接受EGFR-TKI治疗的m阳性患者的生存期显著长于未接受EGFR-TKI治疗的m阴性患者（中位OS [mOS] 36.4个月对11.9个月；风险比HR = 0.38 [95%CI 0.32 - 0.46]，P < 0.001）。Cox回归表明，拥有包括EGFR-TKI报销在内的全面医疗保障的患者，其OS显著长于基本医疗保障的患者（mOS 27.2个月对18.3个月；调整后HR = 0.73 [95%CI 0.59 - 0.90]）。与最佳支持治疗（BSC；参照组）相比，接受EGFR-TKI治疗的患者生存期显著更长（mOS 36.5个月；调整后HR [aHR] = 0.26 [95%CI 0.19 - 0.34]），与单纯化疗（14.5个月；aHR = 0.60 [95%CI 0.47 - 0.78]）相比也是如此。在m阳性患者（n = 422）中，EGFR-TKI治疗的相对生存获益仍然非常显著（aHR[EGFR-TKI] = 0.19 [95%CI 0.12 - 0.29]；aHR（单纯化疗）= 0.50 [95%CI 0.30 - 0.85]；参照组：BSC），表明医疗保障覆盖（报销）影响治疗选择和生存。
结论
我们的分析描述了2012 - 2017年接受治疗的m阳性NSCLC患者中EGFR-TKI治疗的m发生率和生存获益情况，这是泰国最大规模的此类数据集之一。与其他研究一起，这些发现为支持自2021年起在泰国医疗保健计划中扩大厄洛替尼可及性的决定提供了证据，证明了本地真实世界结局数据对医疗政策决策的价值。
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