泰国连续鞘内注射吗啡与癌症疼痛常规治疗的成本效益和成本效用分析：一项为期10年的多中心回顾性研究。

Cost-Effectiveness and Cost-Utility Analyses in Thailand of Continuous Intrathecal Morphine Infusion Compared with Conventional Therapy in Cancer Pain: A 10-year Multicenter Retrospective Study.

作者信息

Thepsuwan Arpawan, Tontisirin Nuj, Euasobhon Pramote, Pannangpetch Patt, Leerapan Borwornsom, Pattanaprateep Oraluck, Cohen Steven P

机构信息

Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Can J Pain. 2023 Jul 28;7(1):2225564. doi: 10.1080/24740527.2023.2225564. eCollection 2023.

DOI:10.1080/24740527.2023.2225564

PMID:37533506

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10392764/

Abstract

BACKGROUND

Because of the high initial cost of intrathecal drug delivery (ITDD) therapy, this study investigated the cost-effectiveness and cost-utility of ITDD therapy in refractory cancer pain management in Thailand over the past 10 years.

METHODS

The retrospective study was conducted in patients with cancer pain who underwent ITDD therapy from January 2011 to 2021 at three university hospitals. Clinical outcomes included the numerical rating scale (NRS), Palliative Performance Scale, and the EQ-5D. The direct medical and nonmedical as well as indirect costs were also recorded. Cost-effectiveness and cost-utility analyses were performed comparing ITDD therapy with conventional therapy (extrapolated from costs of the same patient before ITDD therapy) from a societally oriented economic evaluation.

RESULTS

Twenty patients (F:M: 10:10) aged 60 ± 15 years who underwent implantation of an intrathecal percutaneous port (IT port; = 15) or programmable intrathecal pump (IT pump; = 5) were included. The median survival time was 78 (interquartile range = 121-54) days after ITDD therapy. At 2-month follow-up, the incremental cost-effectiveness ratio (ICER)/pain reduction of an IT port (US$2065.36 (CA$2829.54)/2-point NRS reduction/lifetime) was lower than for patients with an IT pump (US$5479.26 (CA$7506.58)/2-point NRS reduction/lifetime) compared with continued conventional therapy. The ICER/quality-adjusted life years (QALYs) gained for an IT port compared with conventional treatment was US$93,999.31(CA$128,799.06)/QALY gained, which is above the cost-effectiveness threshold for Thailand.

CONCLUSION

The cost-effectiveness and cost-utility of IT port therapy for cancer pain was high relative to the cost of living in Thailand, above the cost-effectiveness threshold. Prospective cost analysis studies enrolling more patients with diverse cancers that investigate the benefit of early ITDD therapy with devices over a range of prices are warranted.

摘要

背景

由于鞘内药物递送（ITDD）疗法初始成本高昂，本研究调查了过去10年中ITDD疗法在泰国难治性癌痛管理中的成本效益和成本效用。

方法

对2011年1月至2021年在三家大学医院接受ITDD疗法的癌痛患者进行回顾性研究。临床结局包括数字评分量表（NRS）、姑息治疗表现量表和EQ-5D。还记录了直接医疗和非医疗以及间接成本。从社会导向的经济评估角度，对ITDD疗法与传统疗法（根据同一患者在接受ITDD疗法之前的成本推算）进行了成本效益和成本效用分析。

结果

纳入了20例年龄为60±15岁的患者（女性：男性=10：10），他们接受了鞘内经皮端口（IT端口；n=15）或可编程鞘内泵（IT泵；n=5）植入。ITDD疗法后中位生存时间为78（四分位间距=121-54）天。在2个月的随访中，与继续接受传统疗法相比，IT端口的增量成本效益比（ICER）/疼痛减轻程度（2065.36美元（2829.54加元）/NRS评分降低2分/终身）低于IT泵患者（5479.26美元（7506.58加元）/NRS评分降低2分/终身）。与传统治疗相比，IT端口获得的ICER/质量调整生命年（QALY）为93,999.31美元（128,799.06加元）/获得的QALY，高于泰国的成本效益阈值。