Launois R J, Reboul-Marty J M, Bonneterre J
Université de Paris-Nord, Faculté de médecine Léonard-de-Vinci, Département de santé publique et d'économie de la santé, Bobigny, France.
Bull Cancer. 1997 Jul;84(7):709-21.
Despite health public problems arised by metastatic breast cancer, specific studies remain rare, and especially when concerning second line chemotherapy. Today, these studies seem essential to allow the clinician, facing the choice between different treatments, to make the best decision. Two recent treatments, docetaxel and paclitaxel, administered every 3 weeks, were compared to the referenced treatment: vinorelbine administered every week. The study aims at evaluating these 3 therapeutic options on second line treatment of metastatic breast cancer. For each of these 3 strategies, our end points were: (1) the duration of progression free survival; (2) the quality adjusted on progression free survival; (3) the cost including the intrinsic cost of chemotherapy as well as the cost of treatment-related and disease-related complications, due to toxicity. Savings obtained with the treatment by delaying relapse were subtracted from expenditure. We used a Markov model to describe the patient's evolution after the administration of the compared treatments. The evaluation concerns the period from the beginning of second line chemotherapy to death. Only direct medical costs were taken into account. Non medical costs and indirect costs were excluded. For each clinical state, resources utilisation was estimated by a retrospective multicentric analysis of 153 medical records of metastatic breast cancer, treated on second line. Resources valuation of hospital costs were based on a national survey on the cost of medical services per DRGs. Quality of life was estimated by a group of nurses in oncology, using the feeling thermometer and standard gamble technics. Incremental cost utility ratios were calculated. Docetaxel reduces the time spent in progression, decreases the number of complications due to progressive disease and thereby provides better quality of life. It provides a benefit of 57 disease- and discomfort-free days, compared to vinorelbine and 22 days compared to paclitaxel. Docetaxel may be thought of as a self-financing strategy as a result of savings in hospital admissions, providing net saving of French Francs (FF) 6,800 in 1993 prices, compared with expenditure associated with vinorelbine treatment and FF 700 compared with the equivalent figures for paclitaxel. A sensitivity analysis confirms the robustness of those results.
尽管转移性乳腺癌引发了诸多公共卫生问题，但相关的具体研究仍然很少，尤其是关于二线化疗的研究。如今，这些研究对于临床医生在面对不同治疗方案时做出最佳决策似乎至关重要。将近期每3周给药一次的多西他赛和紫杉醇这两种治疗方法与参照治疗方法（每周给药一次的长春瑞滨）进行了比较。该研究旨在评估这三种治疗方案用于转移性乳腺癌二线治疗的效果。对于这三种策略中的每一种，我们的终点指标为：（1）无进展生存期的持续时间；（2）基于无进展生存期调整后的质量；（3）成本，包括化疗的内在成本以及因毒性导致的与治疗相关和与疾病相关并发症的成本。将因延迟复发而通过治疗获得的节省从支出中扣除。我们使用马尔可夫模型来描述在给予比较治疗后患者的病情演变。评估涉及从二线化疗开始到死亡的时间段。仅考虑直接医疗成本。排除非医疗成本和间接成本。对于每种临床状态，通过对153例接受二线治疗的转移性乳腺癌医疗记录进行回顾性多中心分析来估计资源利用情况。医院成本的资源估值基于一项关于每个疾病诊断相关分组（DRGs）医疗服务成本的全国性调查。生活质量由一组肿瘤学护士使用感觉温度计和标准博弈技术进行评估。计算了增量成本效用比。多西他赛减少了疾病进展所花费的时间，减少了因疾病进展导致的并发症数量，从而提供了更好的生活质量。与长春瑞滨相比，它带来了57天无疾病和不适的益处，与紫杉醇相比为22天。由于住院次数的节省，多西他赛可被视为一种自筹资金的策略，按照1993年的价格计算，与长春瑞滨治疗相关的支出相比净节省6800法国法郎（FF），与紫杉醇的等效数字相比为700法国法郎。敏感性分析证实了这些结果的稳健性。
