Brown M L, Nayfield S G, Shibley L M
Applied Research Branch, National Cancer Institute, Bethesda, MD 20892.
J Natl Cancer Inst. 1994 Mar 16;86(6):424-30. doi: 10.1093/jnci/86.6.424.
In 1989, the National Cancer Institute issued a clinical announcement advising physicians of the benefits of combined levamisole and fluorouracil as an adjuvant treatment for patients with stage III colon cancer.
We have estimated the cost-effectiveness of the combined treatment and estimated the social return on the National Institutes of Health (NIH) research investment that led to this innovative cancer treatment.
A computer simulation model, CAN*TROL, was used to estimate costs and benefits for a population cross-section receiving the adjuvant treatment. A method similar to "Q-TWiST" was used to assess the impact of quality-of-life adjustments.
For a typical base-line case, the calculated cost-effectiveness is a very favorable $2094 per year of life saved. Using a variety of less favorable assumptions, cost-effectiveness is still less than $5000 per year of life saved, again a favorable value. Quality-of-life adjustments have a negligible effect on the cost-effectiveness outcome. The net present value of the return to the NIH research investment is estimated to be $1.66 billion.
Under a wide range of reasonable assumptions, adjuvant therapy for stage III colon cancer appears to be a very cost-effective procedure. The investment in the research that resulted in this therapy promises to yield a high return.
1989年，美国国立癌症研究所发布了一项临床公告，告知医生左旋咪唑与氟尿嘧啶联合使用作为III期结肠癌患者辅助治疗的益处。
我们评估了联合治疗的成本效益，并估算了美国国立卫生研究院（NIH）促成这种创新癌症治疗方法的研究投资的社会回报。
使用计算机模拟模型CAN*TROL来估算接受辅助治疗的人群横截面的成本和效益。采用一种类似于“质量调整生命年（Q-TWiST）”的方法来评估生活质量调整的影响。
对于典型的基线病例，计算出的成本效益为每挽救一年生命2094美元，非常可观。使用各种不太有利的假设，成本效益仍低于每挽救一年生命5000美元，这也是一个有利的值。生活质量调整对成本效益结果的影响可忽略不计。NIH研究投资回报的净现值估计为16.6亿美元。
在广泛的合理假设下，III期结肠癌的辅助治疗似乎是一种非常具有成本效益的方法。促成这种治疗方法的研究投资有望产生高回报。
