McEwan A J, Amyotte G A, McGowan D G, MacGillivray J A, Porter A T
Cross Cancer Institute, Edmonton, Alta., Canada.
Eur Urol. 1994;26 Suppl 1:26-31. doi: 10.1159/000475428.
A retrospective study was performed on the cost-effectiveness of treatment for advanced prostate cancer metastatic to bone. Patients (n = 29) recruited into the trans Canada trial at the Cross Cancer Institute, Edmonton and randomized to treatment with Metastron (strontium-89 chloride) (n = 14) or placebo (n = 15) after local field irradiation therapy for pain palliation were studied over their entire survival time. Estimates were made of the direct costs of treatment, i.e. drugs (analgesics and hormonal agents) and external radiotherapy, and the indirect costs (investigations, outpatient visits and inpatient days, either total or for tertiary care) based on records from the referring hospital, the cancer clinic and any hospitals to which the patients may subsequently have been referred. Meaningful differences were apparent between the two groups in direct costs with the group receiving Metastron showing a reduction over the entire survival time of Can$ 1,720/person compared with placebo; it should be noted that in this analysis neither the costs of the Metastron, nor of the initial radiotherapy, have been included. The Metastron group also showed a reduction in costs of hospitalization for tertiary care of Can$ 5,696/person, though the total cost of hospitalization was similar in the two groups. These results suggest that treatment with Metastron can bring about reductions in management costs for patients with advanced prostate cancer and, coupled with the findings of the Trans Canada trial on the improvement in quality of life for patients given Metastron, they add financial support to the clinical rationale for the use of Metastron for the palliative treatment of patients with bone metastases resulting from prostate cancer.
对晚期前列腺癌骨转移的治疗成本效益进行了一项回顾性研究。在埃德蒙顿的十字癌症研究所参加跨加拿大试验的患者（n = 29），在接受局部野照射治疗以缓解疼痛后，随机分为用美他生（氯化锶-89）治疗组（n = 14）或安慰剂组（n = 15），对他们的整个生存期进行了研究。根据转诊医院、癌症诊所及患者随后可能转诊至的任何医院的记录，估算了治疗的直接成本，即药物（镇痛药和激素制剂）及外照射放疗的成本，以及间接成本（检查、门诊就诊和住院天数，包括总数或三级护理的天数）。两组在直接成本方面存在明显差异，接受美他生治疗的组在整个生存期内每人比安慰剂组减少了1720加元；应当指出，在此分析中，既未包括美他生的成本，也未包括初始放疗的成本。美他生组三级护理的住院成本也显示每人减少了5696加元，尽管两组的住院总成本相似。这些结果表明，美他生治疗可降低晚期前列腺癌患者的管理成本，并且，结合跨加拿大试验关于接受美他生治疗的患者生活质量改善的结果，它们为使用美他生姑息治疗前列腺癌骨转移患者的临床理论依据提供了经济支持。
