Cox F, Hirsch J
Glaxo Inc., Research Triangle Park, NC 27709.
Oncology. 1993 May-Jun;50(3):186-90. doi: 10.1159/000227175.
A cost-effectiveness analysis is one form of full economic evaluation where drug acquisition costs and the costs that are incurred as a result of using a particular treatment are assessed together with clinical efficacy. This paper reviews two such studies. One of the studies was a prospective randomised cost-effectiveness study which compared ondansetron (8 mg i.v. 0, 4 and 8 h following chemotherapy) with metoclopramide (3 mg/kg i.v. followed by an infusion of 0.5 mg/kg/h for 8 h) over the first 24 h following chemotherapy in hospitalised patients receiving highly emetogenic chemotherapy. This study showed that the cost per successfully treated patient (defined in this study as having < or = 1 emetic episode and no adverse events) for these 2 treatments were approximately equal: ondansetron pounds 95 and metoclopramide pounds 92. The second study was an economic evaluation based on data collected over a 5-day period following cyclophosphamide-based chemotherapy given on an outpatient basis for the treatment of breast cancer. Patients received an intravenous dose of 16 mg dexamethasone with either 8 mg ondansetron or 60 mg metoclopramide intravenously before chemotherapy followed by oral dosing with 8 mg ondansetron or 20 mg metoclopramide 3 times daily for 5 days. The costs per successfully treated patient (defined in this study as no vomiting or retching episodes and no anti-emetic-related adverse events during the 5-day period) were comparable: ondansetron pounds 184 and metoclopramide pounds 160. A recent study has established that ondansetron (8 mg) given orally twice daily is as effective as the same dose given 3 times a day. A sensitivity analysis using the cost of an ondansetron twice daily regimen showed that ondansetron is more cost-effective than metoclopramide (pounds 133 vs. pounds 160). These cost effectiveness studies have shown that ondansetron is at least as cost-effective as metoclopramide and simplified ondansetron dosing schedules render ondansetron more cost-effective. These full economic evaluations illustrate that drug acquisition costs can be a misleading guide to the economic impact of antiemetics.
成本效益分析是全面经济评估的一种形式，在这种评估中，药物购置成本以及因使用特定治疗方法而产生的成本会与临床疗效一同进行评估。本文回顾了两项此类研究。其中一项研究是一项前瞻性随机成本效益研究，该研究在接受高致吐性化疗的住院患者化疗后的头24小时内，将昂丹司琼（化疗后0、4和8小时静脉注射8毫克）与甲氧氯普胺（静脉注射3毫克/千克，随后以0.5毫克/千克/小时的速度输注8小时）进行了比较。这项研究表明，这两种治疗方法每成功治疗一名患者的成本（在本研究中定义为呕吐发作次数≤1次且无不良事件）大致相等：昂丹司琼95英镑，甲氧氯普胺92英镑。第二项研究是一项基于在门诊接受环磷酰胺化疗治疗乳腺癌后5天内收集的数据的经济评估。患者在化疗前静脉注射16毫克地塞米松，同时静脉注射8毫克昂丹司琼或60毫克甲氧氯普胺，随后在5天内每天口服8毫克昂丹司琼或20毫克甲氧氯普胺3次。每成功治疗一名患者的成本（在本研究中定义为在5天内无呕吐或干呕发作且无抗呕吐相关不良事件）具有可比性：昂丹司琼184英镑，甲氧氯普胺160英镑。最近一项研究证实，每天口服两次8毫克的昂丹司琼与每天服用3次相同剂量的效果相同。一项使用每天两次昂丹司琼治疗方案成本的敏感性分析表明，昂丹司琼比甲氧氯普胺更具成本效益（133英镑对160英镑）。这些成本效益研究表明，昂丹司琼至少与甲氧氯普胺一样具有成本效益，并且简化的昂丹司琼给药方案使昂丹司琼更具成本效益。这些全面的经济评估表明，药物购置成本可能会误导对抗呕吐药物经济影响的判断。
