摘要
目的:引入Markov模型评价埃克替尼、吉非替尼和厄洛替尼三种EGFR-TKIs类药物二线治疗晚期非小细胞肺癌(nonsmall cell lung cancer,NSCLC)的经济性,指导临床合理用药。方法:建立埃克替尼、吉非替尼和厄洛替尼治疗晚期NSCLC的Markov模型,分别对三种药物治疗晚期NSCLC患者疾病稳定、疾病缓解、疾病进展和死亡的动态变化进行模拟,同时对成本和效用值进行敏感度分析,找出临床相对较优的治疗药物。结果:Markov模型成本-效用分析显示:3%的贴现率下埃克替尼治疗晚期非小细胞肺癌3年所需累积成本为375594.37元,累积效用为1.50个质量调整生命年;吉非替尼所需累积成本为531222.33元,累积效用为1.51个质量调整生命年;厄洛替尼所需累积成本为694611.22元,累积效用为1.51个质量调整生命年。敏感度分析显示各参数在设定的范围内变化不影响模型分析结论。结论:三种EGFR-TKIs类药物相比,埃克替尼的成本效用比(250396.25元/QALY)远远小于吉非替尼(351802.87元/QALY)和厄洛替尼(460007.43元/QALY),可作为优选方案。因此,应优先选择埃克替尼作为晚期非小细胞肺癌的治疗药物,从而获得更优的经济学效益,使有限的医疗资源利用最大化。
Objective： To evaluate the cost-utility of EGFR-TKIs in the treatment of advanced non-small cell lung cancer（, NSCLC） using Markov mode. Methods： Built Markov state transition model to simulate the dynamic changes of the four states （stable disease, re- sponse ,progressive disease and death） in the patients who received the ieotinib, erlotinib or gefitinib treatment. Applied Markov model u- sing Roll back analysis and Markov cohort simulation to project the costs and utility for the patients who had been long-term treated with EGFR-TKIs. One way sensitivity analysis was carried out to determine the robustness of this baseline results. Results： The results of cost-utility analysis showed that patients receiving icotinib cumulative costs and utilities were 375594. 37 yuan and 1.50 quality-adjusted life years gained. Patients receiving gefitinib cumulative costs and utilities were 531222. 33 yuan and 1.51 quality-adjusted life years gained. Patients receiving erlotinib cumulative costs and utilities were 694611.22 yuan and 1.51 quality-adjusted life years gained. Ac- cording to the sensitivity analysis, the change of key parameters in the set range did not affect the model results. Conclusion： In conclu- sion, icotinib treatment was more economical than gefitinib and erlotinib treatment for NSCLC patients.
出处
《中国药物评价》
2013年第5期305-308,共4页
Chinese Journal of Drug Evaluation
