Messori A, Trippoli S, Becagli P, Tendi E
Laboratorio di Farmacoeconomia, Drug Information Center, Pharmaceutical Service, Azienda Ospedaliera Careggi, Florence, Italy.
Anticancer Drugs. 1998 Jul;9(6):491-502.
The main therapeutic options currently available for patients with newly diagnosed advanced ovarian cancer include: (i) cisplatin-based chemotherapy at conventional doses without paclitaxel, (ii) paclitaxel+cisplatin at conventional doses and (iii) high-dose chemotherapy with autologous hematopoietic rescue. After conducting a literature search to identify large-scale clinical trials based on these three therapeutic modalities, we carried out an analysis of the survival data and evaluated the cost-effectiveness ratio where appropriate. Cost data were obtained from published information. Effectiveness was estimated by determining the values of mean lifetime survival (MLS). Our analysis included a total of 15 clinical trials. The values of MLS were 3.05 years per patient for cisplatin-based chemotherapy at conventional doses without paclitaxel (1931 patients), 2.95 years per patient for chemotherapy with paclitaxel+cisplatin at conventional doses (184 patients) and 5.76 years per patient for high-dose chemotherapy with autologous hematopoietic rescue (53 patients). As compared with cisplatin-based chemotherapy without paclitaxel, high-dose treatments with hematopoietic rescue yielded a significantly better survival. Using cisplatin-based chemotherapy as a reference term, the incremental cost-effectiveness ratio for high-dose treatments was $25641 per life year gained (discounted dollars per discounted life year gained). Sensitivity testing suggested that the ratio remained below $50000 under most circumstances. We conclude that in the treatment of patients with advanced ovarian cancer, high-dose chemotherapy with hematopoietic rescue seems to be more effective and more cost-effective than standard treatments with cisplatin-based regimens at conventional doses.
目前，新诊断出的晚期卵巢癌患者主要的治疗选择包括：（i）常规剂量的基于顺铂的化疗（不含紫杉醇），（ii）常规剂量的紫杉醇 + 顺铂化疗，以及（iii）高剂量化疗并进行自体造血干细胞救援。在进行文献检索以确定基于这三种治疗方式的大规模临床试验后，我们对生存数据进行了分析，并在适当情况下评估了成本效益比。成本数据来自已发表的信息。通过确定平均生存期（MLS）的值来估计疗效。我们的分析共纳入了15项临床试验。常规剂量的基于顺铂的化疗（不含紫杉醇）（1931例患者）的MLS值为每位患者3.05年，常规剂量的紫杉醇 + 顺铂化疗（184例患者）的MLS值为每位患者2.95年，高剂量化疗并进行自体造血干细胞救援（53例患者）的MLS值为每位患者5.76年。与基于顺铂的化疗（不含紫杉醇）相比，高剂量的造血干细胞救援治疗的生存期明显更长。以基于顺铂的化疗作为参照，高剂量治疗的增量成本效益比为每获得一个生命年25641美元（每获得一个贴现生命年的贴现美元数）。敏感性测试表明，在大多数情况下该比值仍低于50000美元。我们得出结论，在晚期卵巢癌患者的治疗中，高剂量化疗并进行造血干细胞救援似乎比常规剂量的基于顺铂方案的标准治疗更有效且更具成本效益。
