Phisalprapa Pochamana, Kositamongkol Chayanis, Korphaisarn Krittiya, Akewanlop Charuwan, Srimuninnimit Vichien, Supakankunti Siripen, Apiraksattayakul Natnasak, Chaiyakunapruk Nathorn
Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Cancers (Basel). 2023 Oct 11;15(20):4930. doi: 10.3390/cancers15204930.
This study conducted a cost-utility analysis and a budget impact analysis (BIA) of outpatient oral chemotherapy versus inpatient intravenous chemotherapy for stage III colorectal cancer (CRC) in Thailand. A Markov model was constructed to estimate the lifetime cost and health outcomes based on a societal perspective. Eight chemotherapy strategies were compared. Clinical and cost data on adjuvant chemotherapy were collected from the medical records of 1747 patients at Siriraj Hospital, Thailand. The cost-effectiveness results were interpreted against a Thai willingness-to-pay threshold of USD 5003/quality-adjusted life year (QALY) gained. A 5-year BIA was performed. Of the eight strategies, CAPOX then FOLFIRI yielded the highest life-year and QALY gains. Its total lifetime cost was also the highest. An incremental cost-effectiveness ratio of CAPOX then FOLFIRI compared to 5FU/LV then FOLFOX, a commonly used regimen USD was 4258 per QALY gained.The BIA showed that when generic drug prices were applied, 5-FU/LV then FOLFOX had the smallest budgetary impact (USD 9.1 million). CAPOX then FOLFIRI required an approximately three times higher budgetary level (USD 25.1 million). CAPOX then FOLFIRI is the best option. It is cost-effective compared with 5-FU/LV then FOLFOX. However, policymakers should consider the relatively high budgetary burden of the CAPOX then FOLFIRI regimen.
本研究对泰国III期结直肠癌（CRC）门诊口服化疗与住院静脉化疗进行了成本效益分析和预算影响分析（BIA）。构建了一个马尔可夫模型，从社会角度估计终生成本和健康结果。比较了八种化疗策略。从泰国诗里拉吉医院1747例患者的病历中收集辅助化疗的临床和成本数据。根据泰国每获得一个质量调整生命年（QALY）支付意愿阈值5003美元来解释成本效益结果。进行了为期5年的预算影响分析。在这八种策略中，先使用CAPOX方案然后使用FOLFIRI方案产生的生命年和QALY增益最高。其终生总成本也是最高的。与常用方案5FU/LV然后FOLFOX相比，先使用CAPOX方案然后使用FOLFIRI方案每获得一个QALY的增量成本效益比为4258美元。预算影响分析表明，当采用仿制药价格时，5-FU/LV然后FOLFOX方案的预算影响最小（910万美元）。先使用CAPOX方案然后使用FOLFIRI方案所需的预算水平大约高出三倍（2510万美元）。先使用CAPOX方案然后使用FOLFIRI方案是最佳选择。与5-FU/LV然后FOLFOX方案相比，它具有成本效益。然而，政策制定者应考虑先使用CAPOX方案然后使用FOLFIRI方案相对较高的预算负担。
