EGFR- TKIs类药物治疗晚期非小细胞肺癌的药物经济学评价

【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(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非小细胞肺癌的Markov模型,分别对三种药物治疗晚期非小细胞肺癌患者疾病稳定、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),是优选方案。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。

Pharmacoeconomic Evaluation of EGFR-TKIs in the Treatment of Advanced Non-small Cell Lung Cancer

Objective: To evaluate the cost-utility of EGFR- TKIs in the treatment of advanced non-small cell lung cancer using Markov mode. Methods: Built Markov state transition model to simulate the dynamic changes of the four states(stable disease,response,progressive disease and death) in the patients who received the gefitinib or erlotinib or icotinib treatment.Applied Markov model using 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. According to the sensitivity analysis, the change of key parameters in the set range did not affect the model results.Conclusion: In conclusion, icotinib treatment was more economical than gefitinib and erlotinib treatment for NSCLC patients.