Cost implications of new treatments for advanced colorectal cancer.
Cost implications of new treatments for advanced colorectal cancer.
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作者：
Wong YN;Meropol NJ;Speier W;Sargent D;Goldberg RM;Beck JR
自1996年以来，已有6种新药用于治疗转移性结直肠癌。虽然前景看好，但这些药物往往是姑息性的，而且比旧的治疗方法要昂贵得多。这项研究的目的是评估包括化疗和/或单抗在内的序贯方案治疗的成本影响。马尔科夫模型评估了1000名新诊断的转移性结直肠癌患者的假设队列。在支持性护理和随后的死亡之前，患者最多接受三条线的治疗。数据来自已发表的多中心II期和随机III期临床试验。对其疗效、毒性和成本进行了敏感性分析。仅使用药品成本，包括新的化疗药物在内的治疗以10万美元/折扣生命年(DLY)的增量成本效益比(ICER)增加存活率。在ICER超过17万美元/DLY的情况下，添加单抗可提高存活率。结果对初始方案的变化最为敏感。即使临床特征(疗效和毒性)有了显著改善，用最有效方案治疗的ICERs仍然非常高。成本效益分析应该是药物开发过程中的常规组成部分，以便医生和患者适当地了解新创新的价值。
Since 1996, six new drugs have been introduced for the treatment of metastatic colorectal cancer. While promising, these drugs are frequently given in the palliative, and are much more expensive than older treatments. The objective of this study is to measure the cost implications of treatment with sequential regimens that include chemotherapy and/or monoclonal antibodies. A Markov model evaluated a hypothetical cohort of 1000 patients with newly diagnosed metastatic colorectal cancer. Patients are treated with up to three lines of treatment prior to supportive care and subsequent death. Data was obtained from published multicenter phase II and randomized phase III clinical trials. Sensitivity analyses were conducted on the efficacy, toxicity and cost. Using drug costs alone, treatment including new chemotherapeutic agents increases survival at an incremental cost effectiveness ratio (ICER) of $100,000/discounted life year (DLY). Addition of monoclonal antibodies improves survival at an ICER of over $170,000/DLY. Results are most sensitive to changes in the initial regimen. Even with significant improvements in clinical characteristics (efficacy and toxicity), treatment with the most effective regimens still have an very high ICERs Treatment of metastatic colorectal cancer with the most effective regimens comes at very high incremental costs. Cost effectiveness analyses should be a routine component of the drug development process, so that physicians and patients are appropriately informed regarding the value of new innovation.
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影响因子：
45.3
作者：
Meropol, Neal J.;Schulman, Kevin A.
通讯作者：
Schulman, Kevin A.
影响因子：
5.9
作者：
BECK, JR;KASSIRER, JP;PAUKER, SG
通讯作者：
PAUKER, SG
影响因子：
45.3
作者：
Hurwitz, HI;Fehrenbacher, L;Kabbinavar, F
通讯作者：
Kabbinavar, F
影响因子：
45.3
作者：
Goldberg, RM;Sargent, DJ;Alberts, SR
通讯作者：
Alberts, SR
影响因子：
158.5
作者：
Hurwitz, H;Fehrenbacher, L;Kabbinavar, F
通讯作者：
Kabbinavar, F