Evans W K
Ottawa Regional Cancer Centre, University of Ottawa, Ontario, Canada.
Oncology (Williston Park). 1998 Mar;12(3 Suppl 4):18-25; discussion 25-6.
Le Chevalier and colleagues have reported results of a randomized controlled clinical trial comparing vinorelbine alone, versus vinorelbine combined with cisplatin, versus standard treatment consisting of vindesine and cisplatin in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Data on survival in the three study arms and estimates of the resources used to treat these patients were extracted from the publication and inserted into Statistics Canada's POpulation HEalth Model (POHEM). This model includes data on diagnostic methods, treatment, and outcomes appropriate for stage at presentation, health care utilization, and direct care costs ($ Canadian) for best supportive care and for several "standard" chemotherapy regimens used to treat advanced NSCLC. POHEM was then used to model the cost of care per patient and the total burden of cost on the Canadian health care system for each of the chemotherapy treatment strategies and for best supportive care. Based on the published survival curves for each of the vinorelbine regimens, it was possible to estimate the survival gain relative to the standard chemotherapy regimens and to best supportive care, and to estimate their cost-effectiveness as cost per life year gained. Based on this analysis, the most cost-effective standard regimen relative to best supportive care was vinblastine/cisplatin, as it increased average survival while reducing costs by $2,846 per case. Vinorelbine/cisplatin increased survival to a greater degree, but inpatient administration costs associated with the delivery of cisplatin increased treatment costs by $2,983 per case and resulted in a cost-effectiveness ratio of $6,386 per life year gained. As high-dose cisplatin is not routinely administered in the inpatient setting in Canadian institutions, estimates were made of the cost of outpatient administration. The cost of outpatient care was $55 less per case demonstrating that this is the most cost-effective way to administer the regimen. Relative to etoposide/cisplatin and vinblastine/cisplatin, outpatient vinorelbine/cisplatin proved to be cost-effective. Various chemotherapy regimens used in the management of advanced NSCLC all fall within the boundaries of cost-effectiveness generally accepted for health care interventions in Canada. Therefore, cost and cost-effectiveness should not be barriers to the utilization of vinorelbine/cisplatin in Canada.
勒谢瓦利埃及其同事报告了一项随机对照临床试验的结果，该试验比较了长春瑞滨单药治疗、长春瑞滨联合顺铂治疗与由长春地辛和顺铂组成的标准治疗方案在晚期非小细胞肺癌（NSCLC）患者治疗中的效果。从该出版物中提取了三个研究组的生存数据以及用于治疗这些患者的资源估计值，并将其插入加拿大统计局的人口健康模型（POHEM）中。该模型包括适用于就诊时分期的诊断方法、治疗和结局数据、医疗保健利用情况以及最佳支持治疗和用于治疗晚期NSCLC的几种“标准”化疗方案的直接护理成本（加元）。然后，使用POHEM对每种化疗治疗策略以及最佳支持治疗的每位患者护理成本和加拿大医疗保健系统的总成本负担进行建模。根据已发表的每种长春瑞滨治疗方案的生存曲线，可以估计相对于标准化疗方案和最佳支持治疗的生存获益，并估计其成本效益，即每获得一个生命年的成本。基于此分析，相对于最佳支持治疗，最具成本效益的标准方案是长春花碱/顺铂，因为它提高了平均生存期，同时每例成本降低了2846加元。长春瑞滨/顺铂在更大程度上提高了生存率，但与顺铂给药相关联的住院给药成本使每例治疗成本增加了2983加元，导致每获得一个生命年的成本效益比为6386加元。由于加拿大机构的住院环境中不常规使用高剂量顺铂，因此对门诊给药成本进行了估计。门诊护理成本每例少55加元，表明这是该方案最具成本效益的给药方式。相对于依托泊苷/顺铂和长春花碱/顺铂，门诊长春瑞滨/顺铂被证明具有成本效益。用于晚期NSCLC管理的各种化疗方案均在加拿大医疗保健干预措施普遍接受的成本效益范围内。因此，成本和成本效益不应成为加拿大使用长春瑞滨/顺铂的障碍。
