大剂量伊马替尼、达沙替尼和尼洛替尼治疗慢性髓性白血病的成本效用分析

目的：分析大剂量伊马替尼、达沙替尼和尼洛替尼治疗对标准剂量伊马替尼耐药的慢性髓性白血病患者的成本效用。方法：计算三种治疗方案下患者的效用和花费的成本，在马尔可夫模型（Markov）中以3个月为周期进行5年的模拟并对结果做成本效用比较。结果：尼洛替尼治疗方案累计成本为1 595 289.10元，健康效用为1.276 4质量调整生命年（QALYs），相比于尼洛替尼，大剂量伊马替尼组的增量成本效用比（ICUR）为-22 759 433.08（￥/QALYs），达沙替尼组为-30 960 469.51（￥/QALYs）。结论：尼洛替尼方案累计成本最低且获得最多的QALYs，为绝对优势方案。

Cost utility analysis of high dose imatinib,dasatinib and nilotinib in treatment of chronic myeloid leukemia

OBJECTIVE To analyze the cost utility of dasatinib,nilotinib and high dose imatinib in treatment of imatinib resistant patients with chronic myeloid leukemia (CML).METHODS In the calculation of patients' utility and costs under the three schemes,the paper made a five-year simulation with a cycle of three months,of which the results were compared for cost and utility.RESULTS The accumulated cost of nilotinib scheme was 1 595 289.10 yuan,with a quality adjusted life year (QALY) of 1.276 4.Compared to nilotinib,incremental cost utility ratio (ICUR) was -22 759 433.08 (￥/QALYs) for imatinib,-30 960 469.51 (￥/QALYs) for dasatinib.CONCLUSION The nilotinib scheme is absolutely dominant with the lowest accumulated cost and most QALYs.