Cost Effectiveness Analysis of Pharmacokinetically-Guided 5-Fluorouracil in FOLFOX Chemotherapy for Metastatic Colorectal Cancer
Cost Effectiveness Analysis of Pharmacokinetically-Guided 5-Fluorouracil in FOLFOX Chemotherapy for Metastatic Colorectal Cancer
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DOI：
10.1016/j.clcc.2014.09.007
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发表时间：
2014-12-01
影响因子：
3.4
通讯作者：
Flowers, Christopher R.
中科院分区：
文献类型：
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作者：
Goldstein, Daniel A.;Chen, Qiushi;Flowers, Christopher R.
根据药代动力学（PK）而不是体表面积（BSA）给药化疗已被证明可以减少药物暴露的个体差异。对于转移性结直肠癌（mCRC）患者，pk引导的5-氟尿嘧啶（5-FU）替代bsa引导的5-FU可降低毒性并提高总生存期（OS）。在本文中，我们使用马尔可夫模型来表明这是一种具有成本效益的策略，每个获得的质量调整生命年（QALY）花费23,000美元。背景：基于BSA给药的化疗导致药物暴露的显著个体差异。一项随机试验显示，与基于bsa的5-FU给药相比，pk引导的mCRC患者的OS增加，毒性降低。本研究的目的是比较在接受FOLFOX （5-FU、亚叶酸钙和奥沙利铂）治疗的mCRC患者中，基于磷酸基5-FU和基于bsa的5-FU给药的成本效益。材料和方法：我们建立了一个马尔可夫模型来评估PK FOLFOX与BSA FOLFOX的成本效益。从拟合的生存模型中推断出进展风险和原因特异性死亡率。不良事件的行政和管理成本是根据2013年医疗保险报销率和平均销售价格估计的。结果：与BSA FOLFOX相比，PK FOLFOX提供2.03个QALYs，成本为50,205美元，而BSA FOLFOX提供1.46个QALYs，成本为37,173美元。每个质量质量的增量成本效益比为22,695美元。在所有单变量和多变量敏感性分析中，ICER仍< 50,000美元/ QALY。结论：在每个QALY阈值为50,000美元时，PK FOLFOX对mCRC具有成本效益。由于PK FOLFOX的成本效益概况和OS优势，它应该在比较有效性研究中进一步评估。
Dosing chemotherapy based on pharmacokinetics (PK) instead of body surface area (BSA) has been shown to decrease interindividual variability in drug exposure. PK-guided 5-fluorouracil (5-FU) instead of BSA-guided 5-FU for patients with metastatic colorectal cancer (mCRC) leads to decreased toxicity and increased overall survival (OS). In this article, we use Markov modeling to show that this is a cost-effective strategy, costing $23,000 per quality-adjusted life-year (QALY) gained.Background: Dosing chemotherapy based on BSA results in marked interindividual variability in drug exposure. A randomized trial showed increased OS and decreased toxicity with PK-guided compared with BSA-based 5-FU dosing in patients with mCRC. The objective of this study was to compare the cost effectiveness of PK-based 5-FU dosing with BSA-based 5-FU dosing in patients with mCRC receiving FOLFOX (5-FU, leucovorin, and oxaliplatin). Materials and Methods: We developed a Markov model to evaluate the cost effectiveness of PK FOLFOX compared with BSA FOLFOX. Progression risks and cause-specific mortality were extrapolated from the fitted survival models. Costs for administration and management of adverse events were estimated based on 2013 Medicare reimbursement rates and average sale prices. Results: PK FOLFOX provided 2.03 QALYs at a cost of $50,205 compared with BSA FOLFOX, which provided 1.46 QALYs at a cost of $37,173. The incremental cost-effectiveness ratio (ICER) was $22,695 per QALY. The ICER remained < $50,000 per QALY in all univariate and multivariate sensitivity analyses. Conclusion: At a $50,000 per QALY threshold, PK FOLFOX is cost effective for mCRC. Because of the cost effectiveness profile and OS advantage with PK FOLFOX, it should be evaluated further in comparative effectiveness studies.