Messori A, Becagli P, Trippoli S, Tendi E
Drug Information Centre, Azienda Ospedaliera Careggi, Florence, Italy.
Eur J Clin Pharmacol. 1996;51(2):111-6. doi: 10.1007/s002280050169.
The analysis of published survival curves can be used as the basis for incremental cost-effectiveness analyses in which two treatments are compared with each other in terms of cost per life year saved. In patients with node-positive breast cancer adjuvant chemotherapy with cyclophosphamide+ methotrexate+fluorouracil has been reported to improve survival in comparison with patients who are not given this treatment.
To assess the pharmacoeconomic profile of this adjuvant chemotherapeutic regimen in terms of cost per life-year gained, we conducted an incremental cost-effectiveness analysis in which the Gompertz model was used to calculate the lifetime estimate of the patient-years gained by treated subjects compared to controls.
Using data from a published, controlled long-term trial involving 207 patients treated with cyclophosphamide+methotrexate+fluorouracil and 179 controls, we estimated that this adjuvant chemotherapy improved life expectancy by 357 patient-years per 100 subjects. Direct costs, which were almost exclusively related to the administration of chemotherapy, were estimated to be US $159,516 per 100 patients. On the basis of these data, adjuvant chemotherapy was found to imply an incremental cost of US $447 per life-year saved.
The cost-effectiveness ratio of adjuvant chemotherapy with cyclophosphamide+methotrexate+fluorouracil in patients with node-positive breast cancer seems to be particularly favourable in comparison with estimates of cost per life-year saved previously calculated for other types of pharmacological intervention.
已发表的生存曲线分析可作为增量成本效益分析的基础，在这种分析中，两种治疗方法根据每挽救一个生命年的成本相互比较。据报道，对于淋巴结阳性乳腺癌患者，与未接受环磷酰胺+甲氨蝶呤+氟尿嘧啶辅助化疗的患者相比，接受该化疗可提高生存率。
为了根据每获得一个生命年的成本评估这种辅助化疗方案的药物经济学特征，我们进行了一项增量成本效益分析，其中使用Gompertz模型计算接受治疗的受试者与对照组相比获得的患者生命年的终生估计值。
利用一项已发表的涉及207例接受环磷酰胺+甲氨蝶呤+氟尿嘧啶治疗的患者和179例对照的对照长期试验的数据，我们估计这种辅助化疗每100名受试者可使预期寿命提高357个患者生命年。直接成本几乎完全与化疗给药相关，估计每100名患者为159,516美元。基于这些数据，发现辅助化疗每挽救一个生命年的增量成本为447美元。
与先前为其他类型的药物干预计算的每挽救一个生命年的成本估计值相比，环磷酰胺+甲氨蝶呤+氟尿嘧啶辅助化疗在淋巴结阳性乳腺癌患者中的成本效益比似乎特别有利。
