Bates M, Lieu D, Zagari M, Spiers A, Williamson T
Technology Assessment Group, San Francisco, California, USA.
Clin Ther. 1997 Jan-Feb;19(1):167-84. doi: 10.1016/s0149-2918(97)80084-7.
A Markov model was developed to determine the cost of treating patients with stage IIIB or IV metastatic breast cancer with 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) and dexrazoxane (administered after six courses of FAC) versus FAC alone. The primary end point in our economic study was cost per cardiac event avoided. Cost per life-year saved was also calculated, even though the survival advantage needs to be confirmed in follow-up studies. The model incorporated the direct medical costs of treating patients with chemotherapy, as well as the costs associated with treatment of any cardiac events that occurred. Data were collected for this analysis from several sources, including completed clinical trials on FAC plus dexrazoxane versus FAC plus placebo (obtained from two patient groups randomized at different time points), a panel of three oncologists, and a panel of three cardiologists. Analyses showed that therapy with dexrazoxane costs $5661.77 per cardiac event prevented. Sensitivity analyses on model variables were performed and showed that the basic results of the model did not change when parameters were varied. The clinical efficacy and cost-effectiveness of dexrazoxane as shown by the results of the current study encourage further investigation of the uses of dexrazoxane in other populations and against other comparators.
开发了一种马尔可夫模型，以确定用5-氟尿嘧啶、多柔比星和环磷酰胺（FAC）以及右丙亚胺（在六个疗程的FAC后给药）与单独使用FAC治疗IIIB期或IV期转移性乳腺癌患者的成本。我们经济研究的主要终点是避免的每个心脏事件的成本。还计算了每挽救一个生命年的成本，尽管生存优势需要在后续研究中得到证实。该模型纳入了化疗治疗患者的直接医疗成本，以及与发生的任何心脏事件治疗相关的成本。该分析的数据来自多个来源，包括关于FAC加右丙亚胺与FAC加安慰剂的完整临床试验（从在不同时间点随机分组的两个患者组获得）、一个由三名肿瘤学家组成的小组和一个由三名心脏病专家组成的小组。分析表明，使用右丙亚胺预防每个心脏事件的成本为5661.77美元。对模型变量进行了敏感性分析，结果表明，当参数变化时，模型的基本结果没有改变。本研究结果显示的右丙亚胺的临床疗效和成本效益鼓励进一步研究右丙亚胺在其他人群中的用途以及与其他对照药物的比较。
