晚期非小细胞肺癌二线治疗不同方案的疗效及成本效益分析

目的 评价多西他赛、培美曲塞、厄洛替尼和吉非替尼4种方案二线治疗晚期非小细胞肺癌（NSCLC）的疗效，并进行成本效益分析。方法 160例晚期NSCLC患者按二线治疗方案分为4组，每组40例。4种方案分别为：多西他赛75mg／m2 iv.，d1；培美曲塞500mg／m2 iv.，d1；厄洛替尼150mg，每日1次；吉非替尼250mg，每日1次。前两组以21天为1周期，共化疗2～6个周期；后两组口服至病情进展或出现无法耐受的不良反应停药。对所有患者进行近期疗效和无进展生存期（PFS）评价，以获得1个单位（1个月）PFS的花费计算4种方案的成本效益比。结果 多西他赛组、培美曲塞组、厄洛替尼组、吉非替尼组有效率分别为7.5％、10.0％、20.0％和22.5％（P=0.165）；疾病控制率分别为32.5％、50.0％、65.0％和52.5％（P=0.035）；中位PFS分别为2.7个月、2.8个月、3.5个月和3.5个月（P=0.677）。4种方案的3～4级不良反应以多西他赛多见。每获得1个单位PFS，4种方案的花费分别为5635.6、10 279.6、20 814.0和17 587.8元；以多西他赛组为参照，培美曲塞组、厄洛替尼组和吉非替尼组的成本-效益比分别为46 434.7、119 729.4和103 171.0元／月。敏感度分析与成本效益分析的结论一致。结论 多西他赛、培美曲塞、厄洛替尼和吉非替尼4种二线治疗方案治疗晚期NSCLC的疗效未见差异，多西他赛方案的成本-效益比最优；厄洛替尼或吉非替尼治疗的花费高，但不良反应较轻。

Effect and cost-efficacy analysis of the second-line treatment of advanced non-small cell lung cancer

Objective To evaluate the effect and cost-efficacy of the second-line treatment of advanced non-small cell lung cancer（NSCLC） by regimens of docetaxel, pemetrexed, erlotinib and gefitinb. Methods A total of 160 patients with advanced NSCLC were assigned to docetaxel, pemetrexed, erlotinib and gefitinb groups （40 cases in each group ）. The dosages of the 4 drugs were doeetaxel 75mg/m^2 d1, pemetrexcd 500mg/m^2 dr, erlotinib 150 mg/d and gefitinb 250mg/d. The former two regimens were given 2-6 cycles（21 days as a cycle）. The later two regimens were given till the disease progressed or intolerant side effect emerged. The ef- fective rate, disease control rate, progress-free survival（PFS） and cost-efficacy ratio were analyzed. Results The effective rate of docetaxel, pemetrexed, erlotinib and gefitinb group was 7.5% , 10.0% , 20. 0% and 22. 5% （ P = 0. 165 ） ; disease control rate was 32.5% , 50. 0%, 65.0% and 52. 5% （P =0. 035） ;median PFS was 2. 7, 2. 8, 3.5 and 3.5months （P =0. 677） ; the cost of per unit （ 1 month） increasing of PFS was 5635.6, 10 279. 6, 20 814. 0 and 17 587. 8 yuan. Taking docetaxel group as control, the cost-efficacy ratio of pemetrexed, erlotinib and gefitinb group was 46 434.7, 119 729. 4 and 103 171.0 yuan/month. The sensitivity analysis supported the results of benefit-cost evaluation. Conclusion Docetaxel, pemetrexed, erlotinib and gefitinb have no statistically significance in the second-line treatment of advanced NSCLC. Docetaxel had better cost-efficacy. Erlotinib and gefitinb have less side effects but the most expensive cost.