作者:Ruth E. Brown、John Hutton、Anita Burrell
DOI:10.2165/00019053-200119110-00003
日期:——
Objective: To compare clinical and economic study data for docetaxel, paclitaxel and vinorelbine in the treatment of anthracycline-resistant advanced breast cancer. Study design and methods: A Markov decision-analysis model to simulate the clinical course of a ‘typical’ patient with advanced breast cancer during salvage chemotherapy was updated with response rates and adverse effect rates from phase III clinical trial data for docetaxel, paclitaxel and vinorelbine. Costs were taken from UK national databases and hospitals. Utilities were estimated from 30 oncology nurses in the UK using the standard gamble method. Perspective: National Health Service. Results: When compared with other chemotherapeutic agents, docetaxel has been shown to increase response rate, time to progression and survival in patients with advanced breast cancer. In the base-case analysis, the incremental cost-utility ratio for docetaxel versus paclitaxel was £1995 per quality-adjusted life year (QALY) gained (1998 values). The incremental cost-utility ratio for docetaxel versus vinorelbine was £14 055 per QALY gained. In the comparison with vinorelbine, docetaxel provided the equivalent of an additional 92 days of perfect health. Sensitivity analyses confirmed the robustness of the model and the validity of the base-case analysis results. Even in the worst case scenarios, docetaxel remained cost effective compared with paclitaxel and vinorelbine. Conclusions: These findings support the use of the taxoids, notably docetaxel, in the management of advanced breast cancer.
目标:比较多柔比星、紫杉醇和长春瑞滨在治疗抗蒽环类药物耐药晚期 breast cancer 中的临床和经济研究数据。研究设计和方法:更新了一个马尔可夫决策分析模型,用于模拟“典型”晚期乳腺癌患者在救治化疗期间的临床过程,该模型根据多柔比星、紫杉醇和长春瑞滨的三期临床试验数据更新了响应率和不良反应的发生率。成本数据来源于英国的国家数据库和医院。效用通过标准赌注法由30名英国肿瘤护士估算。视角:国家卫生服务。结果:与其他化疗药物比较,多柔比星在晚期乳腺癌患者中已显示出提高响应率、进展时间和生存率。在基线分析中,多柔比星与紫杉醇相比的增量成本效用比为每增加一个质量调整生命年(QALY)1995英镑(1998年数据)。多柔比星与长春瑞滨相比的增量成本效用比为每增加一个QALY 14055英镑。在与长春瑞滨的比较中,多柔比星提供了相当于额外92天完美健康的效益。敏感性分析确认了模型的稳健性和基线分析结果的有效性。即使在最坏的情况下,多柔比星与紫杉醇和长春瑞滨相比仍然具有成本效益。结论:这些发现支持在晚期乳腺癌管理中使用紫杉类药物,特别是多柔比星。