晚期胃肠道癌姑息化疗的成本效益

Cost-effectiveness of palliative chemotherapy in advanced gastrointestinal cancer.

作者信息

Glimelius B, Hoffman K, Graf W, Haglund U, Nyrén O, Påhlman L, Sjödén P O

机构信息

Department of Oncology, University of Uppsala, Sweden.

出版信息

Ann Oncol. 1995 Mar;6(3):267-74. doi: 10.1093/oxfordjournals.annonc.a059157.

DOI:10.1093/oxfordjournals.annonc.a059157

PMID:7542021

Abstract

BACKGROUND

Chemotherapy may relieve tumor-related symptoms, may improve quality of life and prolong survival in advanced gastrointestinal cancer. The extent of such improvements is unclear despite the extensive use of this treatment modality, and there are no studies concerning the economic cost of any gain achieved in the quantity and quality of life by chemotherapy.

PATIENTS AND METHODS

Between January 1991 and May 1992, 61 patients with inoperable cancer (18 gastric, 22 pancreatic or biliary, and 21 colorectal) were randomized to either primary chemotherapy in addition to best supportive care or to best supportive care. Chemotherapy was allowed in the latter group if the supportive measures did not achieve palliation. All economic costs for medical care were prospectively recorded, and marginal cost-effectiveness analyses were performed.

RESULTS

More patients in the primary chemotherapy group (19/33, 58%) had improved/prolonged high quality of life (QoL-patient, minimum duration 4 months) than in the best supportive care group (8/28, 29%, p < 0.05). Overall survival and quality-adjusted survival were significantly longer in the primary chemotherapy group (median 9 vs. 4 months, p < 0.05), and median 7 vs. 2 months, p < 0.05, respectively). When analysed by cancer site, survival was significantly prolonged in gastric cancer patients (median 10 vs. 4 months, p < 0.02), but not in colorectal (median 12 vs. 6 months, p = 0.1) and pancreatic-biliary cancer patients (median 8 vs. 5 months, p = 0.8). The average cost for all medical care was approximately 50% higher in the primary chemotherapy group, but the average cost per day was the same in the two groups. Hospitalization accounted for most of the costs in both groups. The incremental costs per gained year of life was SEK 166,400 ($21,300), per gained quality-adjusted year of life SEK 157,200 ($20,200), and per QoL-patient SEK 160,300 ($20,600). These costs were lower for gastric and colorectal cancer patients, and much higher for pancreatic-biliary cancer patients.

CONCLUSIONS

The results of this study suggest that palliative chemotherapy is cost-effective in patients with advanced gastric and colorectal cancer. Knowledge about survival and quality of life benefits is still limited in patients suffering from gastric and pancreatic-biliary cancer.

摘要

背景

化疗可缓解晚期胃肠道癌的肿瘤相关症状，改善生活质量并延长生存期。尽管这种治疗方式被广泛应用，但其改善程度尚不清楚，且尚无关于化疗在生活质量和数量方面所获收益的经济成本的研究。

患者与方法

1991年1月至1992年5月期间，61例无法手术的癌症患者（18例胃癌、22例胰腺癌或胆管癌、21例结直肠癌）被随机分为两组，一组接受除最佳支持治疗外的一线化疗，另一组仅接受最佳支持治疗。若支持治疗未达到姑息效果，后一组也可进行化疗。前瞻性记录所有医疗护理的经济成本，并进行边际成本效益分析。

结果

一线化疗组中更多患者（19/33，58%）生活质量得到改善/延长（高质量生活，患者，最短持续时间4个月），高于最佳支持治疗组（8/28，29%，p<0.05）。一线化疗组的总生存期和质量调整生存期显著更长（中位数分别为9个月对4个月，p<0.05），以及中位数7个月对2个月，p<0.05）。按癌症部位分析，胃癌患者生存期显著延长（中位数10个月对4个月，p<0.02），但结直肠癌患者（中位数12个月对6个月，p = 0.1）和胰腺癌或胆管癌患者（中位数8个月对5个月，p = 0.8）未延长。一线化疗组所有医疗护理的平均成本约高50%，但两组每日平均成本相同。两组中住院费用占大部分成本。每增加一年生命的增量成本为166,400瑞典克朗（21,300美元），每增加一个质量调整生命年为157,200瑞典克朗（20,200美元），每增加一个高质量生活患者为160,300瑞典克朗（20,600美元）。胃癌和结直肠癌患者的这些成本较低，而胰腺癌或胆管癌患者的成本则高得多。