干扰素治疗慢性粒细胞白血病的成本效益：四项临床研究分析

Cost-effectiveness of interferon in chronic myeloid leukaemia: analysis of four clinical studies.

作者信息

Messori A

机构信息

Italian Cooperative Group for the Study of Meta-analysis, Azienda Ospedaliera Careggi, Florence, Italy.

出版信息

Ann Oncol. 1998 Apr;9(4):389-96. doi: 10.1023/a:1008212411489.

DOI:10.1023/a:1008212411489

PMID:9636829

Abstract

BACKGROUND

Analysis of published survival curves can be used as the basis for incremental cost-effectiveness analyses in which two treatments are compared with one another in terms of cost per life-year saved. In patients with chronic myeloid leukaemia in chronic phase, long-term treatment with alpha-interferon has been reported to improve survival in comparison with standard treatments with cytotoxic drugs. To assess the pharmacoeconomic profile of interferon treatment in terms of cost per life-year gained, we conducted an incremental cost-effectiveness analysis.

PATIENTS AND METHODS

The clinical material utilised in our analysis derived from four published randomised trials comparing interferon vs. busulphan or hydroxyurea. The Gompertz model was used to estimate the total lifetime values of patient-years of subjects receiving interferon in comparison with subjects given a standard cytotoxic treatment.

RESULTS

Our primary analysis showed that maintenance treatment with interferon improved survival expectancy by 37 to 93 discounted years for every 100 patients. The incremental cost-effectiveness ratio of interferon vs. cytotoxic therapy ranged from $93,000 to $226,000 per life-year gained (discounted costs per discounted years). A secondary analysis showed that the dose of interferon had significant influence on the cost-effectiveness ratio. Because our literature search identified a fifth study that showed an extremely favourable outcome using interferon but that was not included in our primary analysis due to its design, we conducted another secondary analysis based on these five studies that, however, confirmed the results of the primary analysis.

CONCLUSIONS

Our study indicates that an unselected long-term treatment with interferon implies an unfavourable cost effectiveness ranking in comparison with data of cost per life-year gained which had previously been obtained from other types of medical intervention.

摘要

背景

已发表的生存曲线分析可作为增量成本效益分析的基础，在该分析中，两种治疗方法可就每挽救一个生命年的成本进行相互比较。据报道，对于慢性期慢性髓性白血病患者，与使用细胞毒性药物的标准治疗相比，长期使用α干扰素治疗可提高生存率。为了根据每获得一个生命年的成本评估干扰素治疗的药物经济学概况，我们进行了增量成本效益分析。

患者与方法

我们分析中使用的临床资料来自四项已发表的随机试验，这些试验比较了干扰素与白消安或羟基脲。采用Gompertz模型估计接受干扰素治疗的受试者与接受标准细胞毒性治疗的受试者的患者年总生存期价值。

结果

我们的初步分析表明，每100例患者中，干扰素维持治疗可使预期生存期提高37至93个贴现年。干扰素与细胞毒性治疗的增量成本效益比为每获得一个生命年93,000美元至226,000美元（每贴现年的贴现成本）。二次分析表明，干扰素剂量对成本效益比有显著影响。由于我们的文献检索发现了第五项研究，该研究显示使用干扰素的结果极为有利，但由于其设计原因未纳入我们的初步分析，我们基于这五项研究进行了另一项二次分析，然而，该分析证实了初步分析的结果。