Brown R E, Hutton J
MEDTAP International, Inc, Bethesda, MD 20814, USA.
Anticancer Drugs. 1998 Nov;9(10):899-907. doi: 10.1097/00001813-199811000-00009.
Relevant data from direct comparisons in clinical trials are not available for economic evaluations of docetaxel and paclitaxel in the management of metastatic breast cancer. A modified Markov model is used to estimate the incremental cost in US$ per quality-adjusted life-year (QALY) for docetaxel versus paclitaxel in managing metastatic breast cancer patients in the US. The model incorporates the latest available clinical trial data (response rates of 47.8% for docetaxel and 25% for paclitaxel, chemotherapy-specific toxicities, time to progression, and 1-year survival) from studies against other comparators. Medical care resources were estimated by US oncologists and costed using US data sources. Utility scores were obtained from 29 US oncology nurses. The base case and subsequent sensitivity analyses show that docetaxel management of advanced breast cancer is more costly per patient but yields higher health benefits than paclitaxel therapy. The cost per QALY gained by docetaxel is $8615, and ranges between $3943 and $9416 in sensitivity analyses. These results confirm those of an earlier model using preliminary data and compare favorably with other cost-utility results in this patient group.
在转移性乳腺癌治疗中，关于多西他赛和紫杉醇的经济学评估，尚无来自临床试验直接比较的相关数据。采用一种改良的马尔可夫模型，来估算在美国治疗转移性乳腺癌患者时，多西他赛相对于紫杉醇每质量调整生命年（QALY）的增量成本（以美元计）。该模型纳入了针对其他对照物的研究中的最新临床试验数据（多西他赛的缓解率为47.8%，紫杉醇为25%，化疗特异性毒性、疾病进展时间和1年生存率）。美国肿瘤学家估算了医疗护理资源，并使用美国数据源进行成本核算。效用评分来自29名美国肿瘤护士。基础病例及后续敏感性分析表明，晚期乳腺癌的多西他赛治疗每位患者的成本更高，但比紫杉醇治疗产生更高的健康效益。多西他赛获得每QALY的成本为8615美元，在敏感性分析中介于3943美元至9416美元之间。这些结果证实了早期使用初步数据的模型的结果，并且与该患者群体的其他成本效用结果相比具有优势。
