根治性非小细胞肺癌治疗方案方案管理直接医疗成本的比较成本分析：约旦的微观成本研究

Comparative Cost Analysis for Direct Medical Costs of Protocol Administration of Non-Small Cell Lung Cancer Treatment Regimens in Curative Intent: A Micro-Costing Study in Jordan.

作者信息

Madae'en Saba S, Salem Ahmed A, Ararawi Naila S, Ramzi Ezaldeen J, Aloueedat Roa'a F, Saabenh Abdullah M, Allouzi Diala A, Abuoudeh Reem H, Hnaif Osama E, Musa Leen M, Alshdaifat Salma H, Al-Tanashat Ahmad J, Almasa'afeh Hala Y, Abuallaban Salma M

机构信息

Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Jordan.

Department of Anatomy, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, Zarqa, Jordan.

出版信息

Clinicoecon Outcomes Res. 2025 Jul 12;17:455-471. doi: 10.2147/CEOR.S520119. eCollection 2025.

DOI:10.2147/CEOR.S520119

PMID:40678407

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12267825/

Abstract

BACKGROUND

Non-small cell lung cancer (NSCLC) treatment costs significantly impact healthcare systems. This study analyzes direct costs and cost drivers of perioperative and adjuvant systemic treatments for stage I-II NSCLC from Jordanian healthcare providers' perspective using micro-costing methodology.

METHODS

We employed micro-costing to analyze direct medical expenses including drug acquisition, preparation, administration, pre/post-medications, diagnostics, labor, and wastage costs for perioperative regimens used in stage I-II NSCLC. International guidelines defined therapeutic regimens, while drug prices were extracted from Jordan Food and Drug Administration's database. Published data and surveys quantified micro-costs.

RESULTS

Among 26 assessed regimens (2 targeted therapy, 10 chemotherapy, 10 chemo-immunotherapy, 4 immunotherapy), targeted/immunotherapy agents significantly increased costs. Chemotherapy regimen cost differences ranged from $633.68 (squamous) to $1,763.91 (non-squamous) per cycle. Antineoplastic agents were primary cost drivers, highest for Durvalumab (98.72% of cycle cost). Laboratory costs comprised up to 50.73% in chemotherapy and 7.24% in immunotherapy regimens. Wastage contributed up to 10.36% of total cycle costs. Average administration cost was $35 per cycle. Maximum cycle costs were: targeted therapy (Osimertinib) $7,206.44, immunotherapy (Durvalumab) $9,057.71, immune-chemotherapy (Durvalumab-Carboplatin-Pemetrexed) $11,358.43, and chemotherapy (Carboplatin-Pemetrexed) $2,300.72.

CONCLUSION

Our results highlight the substantial economic impact and cost variability among treatment regimens. This variability presents opportunities for cost reduction through careful selection of therapeutically equivalent regimens based on pricing and toxicity profiles. The findings emphasize the need for comprehensive and precise cost analysis to inform healthcare policies and clinical practices. Future research should focus on cost-effectiveness analyses of these expensive agents to ensure value for money, support evidence-based decision-making, and strengthen price negotiations with suppliers.

摘要

背景

非小细胞肺癌（NSCLC）的治疗成本对医疗保健系统有重大影响。本研究采用微观成本核算方法，从约旦医疗服务提供者的角度分析I-II期NSCLC围手术期和辅助全身治疗的直接成本及成本驱动因素。

方法

我们采用微观成本核算来分析直接医疗费用，包括I-II期NSCLC围手术期治疗方案的药品采购、配制、给药、用药前/后处理、诊断、人工及浪费成本。国际指南界定了治疗方案，药品价格从约旦食品药品管理局的数据库中提取。已发表的数据和调查对微观成本进行了量化。

结果

在评估的26种治疗方案（2种靶向治疗、10种化疗、10种化疗免疫治疗、4种免疫治疗）中，靶向/免疫治疗药物显著增加了成本。化疗方案每个周期的成本差异从633.68美元（鳞状细胞癌）到1763.91美元（非鳞状细胞癌）不等。抗肿瘤药物是主要的成本驱动因素，度伐利尤单抗的成本占比最高（占周期成本的98.72%）。实验室成本在化疗方案中占比高达50.73%，在免疫治疗方案中占7.24%。浪费占总周期成本的比例高达10.36%。平均给药成本为每个周期35美元。每个周期的最高成本分别为：靶向治疗（奥希替尼）7206.44美元、免疫治疗（度伐利尤单抗）9057.71美元、免疫化疗（度伐利尤单抗-卡铂-培美曲塞）11358.43美元、化疗（卡铂-培美曲塞）2300.72美元。

结论

我们的结果凸显了治疗方案之间巨大的经济影响和成本差异。这种差异为通过根据价格和毒性特征谨慎选择治疗等效方案来降低成本提供了机会。研究结果强调需要进行全面而精确的成本分析，以为医疗政策和临床实践提供参考。未来的研究应侧重于对这些昂贵药物进行成本效益分析，以确保物有所值，支持基于证据的决策，并加强与供应商的价格谈判。