Bloomfield D J, Krahn M D, Neogi T, Panzarella T, Smith T J, Warde P, Willan A R, Ernst S, Moore M J, Neville A, Tannock I F
Department of Medical Oncology, Princess Margaret Hospital, Ontario, Canada.
J Clin Oncol. 1998 Jun;16(6):2272-9. doi: 10.1200/JCO.1998.16.6.2272.
To evaluate the economic consequences of the use of chemotherapy in patients with symptomatic hormone-resistant prostate cancer (HRPC) in the context of a previously published Canadian open-label, phase III, randomized trial with palliative end points.
The trial randomized 161 patients to initial treatment with mitoxantrone and prednisone (M + P) or to prednisone alone (P) and showed better palliation with M + P. There was no significant difference in survival. A detailed retrospective chart review was performed of resources used from randomization until death of 114 of 161 patients enrolled at the three largest centers: these included hospital admissions, outpatient visits, investigations, therapies (which included all chemotherapy and radiation), and palliative care. Cancer center and community hospital costs were calculated by using the hotel approximation method and case costing from the Ontario Case Cost Project, respectively. Cost-utility analysis was performed by transforming the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 global quality-of-life item measured every 3 weeks on trial to an estimate of utility, and extending the last known value through to death or last follow-up.
The mean total cost until death or last follow-up by intention-to-treat was M + P CDN $27,300; P CDN $29,000. The 95% confidence intervals on the observed cost difference ranged from a saving of $9,200 for M + P (with palliative benefit) to an increased cost of $5,800 for M + P. The major proportion of cost (M + P 53% v P 66%; CDN $14,500 v $19,100) was for inpatient care. Initial M + P was consistently less expensive in whichever time period was used to compare costs. Cost-utility analysis showed M + P to be the preferred strategy with an upper 95% confidence interval for the incremental cost-utility ratio of CDN $19,700 per quality-adjusted life-year (QALY).
A treatment that reduces symptoms and improves quality of life has the potential to reduce costs in other areas. Economic factors should not influence the clinical decision as to whether to use M + P in a symptomatic patient.
在一项先前发表的以姑息治疗为终点的加拿大开放标签、III期随机试验背景下，评估对有症状的激素抵抗性前列腺癌（HRPC）患者使用化疗的经济后果。
该试验将161例患者随机分为初始接受米托蒽醌和泼尼松（M + P）治疗或仅接受泼尼松（P）治疗，结果显示M + P的姑息治疗效果更好。生存率无显著差异。对在三个最大中心入组的161例患者中的114例进行了详细的回顾性病历审查，审查内容为从随机分组至死亡期间所使用的资源，包括住院、门诊就诊、检查、治疗（包括所有化疗和放疗）以及姑息治疗。癌症中心和社区医院的费用分别采用酒店近似法和安大略病例成本项目的病例成本计算法进行计算。通过将在试验中每3周测量一次的欧洲癌症研究与治疗组织（EORTC）QLQ - C30全球生活质量项目转换为效用估计值，并将最后已知值延伸至死亡或最后一次随访，进行成本效用分析。
在意向性治疗分析中，直至死亡或最后一次随访的平均总成本为：M + P组27,300加元；P组29,000加元。观察到的成本差异的95%置信区间范围为，M + P组节省9,200加元（有姑息治疗益处）至M + P组成本增加5,800加元。成本的主要部分（M + P组占53%，P组占66%；分别为14,500加元和19,100加元）用于住院治疗。无论采用哪个时间段比较成本，初始M + P治疗始终成本更低。成本效用分析表明，M + P是首选策略，增量成本效用比的95%置信区间上限为每质量调整生命年（QALY）19,700加元。
一种能够减轻症状并改善生活质量的治疗方法有可能降低其他方面的成本。经济因素不应影响对于有症状患者是否使用M + P的临床决策。
