Hillner B E
Department of Internal Medicine, Massey Cancer Center, Virginia Commonwealth University, Richmond 23298, USA.
Eur J Cancer. 1998 Jul;34 Suppl 3:S18-21. doi: 10.1016/s0959-8049(98)00002-1.
The use of interferon alfa-2b (IFN-alpha 2b) as adjuvant therapy of high-risk resected cutaneous melanoma was recently found to significantly improve relapse-free and overall survival in the Eastern Cooperative Oncology Group trial 1684 (E1684). However, treatment toxicities and costs may limit its widespread use. A cost-effectiveness and cost-utility analysis of this therapy was conducted using a hypothetical cohort of patients as if they had entered E1684. Survival and recurrence rates were calculated at 7 and 35 years for typical 50-year-old melanoma patients based on the clinical results of E1684 and natural history databases. Costs included all treatment-related costs (i.e. drug acquisition and administration, monitoring and treatment-related toxicity) and the costs of treating recurrences. Estimated utility values were assigned based on data from other oncology trials. The model predicted that IFN-alpha 2b provided an extra 0.52 years of life compared with observation at 7 years; however, at 35 years, the survival benefit of IFN-alpha 2b increased almost 4-fold to nearly 2 years. At 7 years, the cost per year of life gained was U.S. $32,600 and the cost per quality-adjusted life-year (QALY) gained was U.S. $43,200. At 35 years, these costs decreased to U.S. $13,700 and $15,200, respectively. These costs are comparable with those of other well-established medical interventions. Although these results require confirmation in a prospective study, it appears that the use of high-dose IFN-alpha 2b for patients with high-risk melanoma is cost-effective.
近期在东部肿瘤协作组试验1684（E1684）中发现，使用干扰素α-2b（IFN-α 2b）作为高危切除性皮肤黑色素瘤的辅助治疗可显著提高无复发生存率和总生存率。然而，治疗毒性和成本可能会限制其广泛应用。我们使用一组假设的患者队列进行了该疗法的成本效益和成本效用分析，就好像他们参加了E1684试验一样。根据E1684的临床结果和自然病史数据库，计算了典型的50岁黑色素瘤患者在7年和35年时的生存率和复发率。成本包括所有与治疗相关的费用（即药物采购和给药、监测以及与治疗相关的毒性）以及治疗复发的费用。根据其他肿瘤学试验的数据分配估计的效用值。该模型预测，与观察相比，IFN-α 2b在7年时可使患者多存活0.52年；然而，在35年时，IFN-α 2b的生存获益增加了近4倍，接近2年。在7年时，每获得一年生命的成本为32,600美元，每获得一个质量调整生命年（QALY）的成本为43,200美元。在35年时，这些成本分别降至13,700美元和15,200美元。这些成本与其他成熟的医疗干预措施相当。尽管这些结果需要在前瞻性研究中得到证实，但对于高危黑色素瘤患者使用高剂量IFN-α 2b似乎具有成本效益。
