Ortega A, Dranitsaris G, Puodziunas A L
Department of Pharmaceutical Services, Princess Margaret Hospital, Toronto, Ontario, Canada.
Cancer. 1998 Dec 15;83(12):2588-96. doi: 10.1002/(sici)1097-0142(19981215)83:12<2588::aid-cncr26>3.0.co;2-m.
Anemia, one of the most common complications of cancer chemotherapy, has been managed with red blood cell (RBC) transfusions. As an alternative, the agent epoetin alfa has the potential to reduce the transfusion requirements of patients receiving cancer chemotherapy. To estimate the value that cancer patients place on the drug, an economic analysis using the concept of willingness to pay (WTP) was conducted.
The method of WTP was used within the framework of a classical cost-benefit analysis to estimate the net cost or benefit of administering prophylactic epoetin alfa to cancer patients. This estimate included the direct cost of epoetin alfa administration and savings secondary to reduced RBC transfusions. A cohort of 100 cancer patients who received or were scheduled to receive cisplatin or noncisplatin chemotherapy (50 per group) were then interviewed to measure the maximum WTP (net benefit) that they experienced with epoetin alfa.
Regarding the benefits they would experience after 3 months of epoetin alfa administration, patients receiving cisplatin and noncisplatin therapy stated that they would be willing to pay an average of 587 U.S. dollars (U.S.$587) (95%CI: $300-$875) and U.S.$613 (95%CI: $324-$902), respectively. These benefits were then subtracted from the total cost of the drug when administered to patients receiving cisplatin (U.S.$3530) and noncisplatin (U.S.$3653) therapy. This produced a net incremental treatment cost of U.S.$2943 (95%CI: $2655-$3230) and U.S.$3039 (95%CI: $2750-$3328) for the respective treatment groups.
The results of the current study suggest that the routine administration of epoetin alfa to cancer patients receiving myelosuppressive chemotherapy is a highly resource-intensive treatment policy with modest benefit to patients. Additional research is required to identify high risk patient subgroups who would benefit most from the drug. [See editorial on pages 2427-9, this issue.]
贫血是癌症化疗最常见的并发症之一，一直通过输注红细胞（RBC）来治疗。作为一种替代方法，促红细胞生成素α药物有潜力减少接受癌症化疗患者的输血需求。为了评估癌症患者对该药物的重视程度，进行了一项使用支付意愿（WTP）概念的经济分析。
在经典成本效益分析框架内使用WTP方法，以估计给癌症患者预防性使用促红细胞生成素α的净成本或效益。该估计包括促红细胞生成素α给药的直接成本以及因减少RBC输血而产生的节省费用。然后对一组100名接受或计划接受顺铂或非顺铂化疗的癌症患者（每组50名）进行访谈，以测量他们使用促红细胞生成素α所经历的最大WTP（净效益）。
关于使用促红细胞生成素α 3个月后他们将体验到的益处，接受顺铂和非顺铂治疗的患者表示，他们分别愿意平均支付587美元（95%CI：300美元 - 875美元）和613美元（95%CI：324美元 - 902美元）。然后从给接受顺铂（3530美元）和非顺铂（3653美元）治疗患者使用该药物的总成本中减去这些益处。这分别为相应治疗组产生了2943美元（95%CI：2655美元 - 3230美元）和3039美元（95%CI：2750美元 - 3328美元）的净增量治疗成本。
本研究结果表明，对接受骨髓抑制性化疗的癌症患者常规使用促红细胞生成素α是一项资源高度密集的治疗策略，对患者的益处有限。需要进一步研究以确定最能从该药物中获益的高风险患者亚组。[见本期第2427 - 2429页的社论。]
