Cancer care cost-effectiveness in low-income and middle-income countries: time to shift the burden of proof.
Cancer care cost-effectiveness in low-income and middle-income countries: time to shift the burden of proof.
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低收入和中等收入国家的癌症护理成本效益：是时候转移举证责任了。
DOI：
10.1016/s2214-109x(22)00289-3
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Painschab,MatthewS
中科院分区：
文献类型：
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作者：
Painschab,MatthewS
卡波西肉瘤是撒哈拉以南非洲地区最常见的癌症之一，发病率和死亡率都很高。卡波西肉瘤是由卡波西肉瘤疱疹病毒引起的。尽管在艾滋病毒流行之前，人们就认识到卡波西肉瘤是地方性的，但艾滋病毒却推动了与艾滋病相关的这种疾病的流行。鉴于卡波西肉瘤在边缘社区的发生率，研究长期资金不足。然而，在高收入国家，晚期卡波西肉瘤的首选一线治疗方法是聚乙二醇化脂质体多柔比星（PLD）或紫杉醇，在这些国家，治疗费用通常不是限制因素。在撒哈拉以南非洲，尽管最近的研究提高了我们对化疗反应的理解，但关于卡波西肉瘤结局的长期、前瞻性数据很少。具体来说，最近在肯尼亚、马拉维、乌干达、南非、津巴布韦和巴西进行的一项艾滋病临床试验组和艾滋病恶性肿瘤联盟试验4将晚期卡波西肉瘤患者随机分配到紫杉醇、博莱霉素-长春新碱或依托泊苷组。主要终点是48周时的无进展生存期（PFS）。紫杉醇（48周PFS 64%）优于博莱霉素-长春新碱（44%）和依托泊苷（20%）。据我们所知，在撒哈拉以南非洲地区没有PLD的随机前瞻性数据，6尽管艾滋病恶性肿瘤协会计划进行一项随机对照试验。尽管紫杉醇具有临床优势，但紫杉醇的应用进展缓慢。在本期的《柳叶刀全球健康》杂志上，Esther Freeman及其同事利用撒哈拉以南非洲地区公布的临床数据和肯尼亚的成本数据，对四种化疗方案（即PLD、依托泊苷、博莱霉素-长春新碱和紫杉醇）的成本效益进行了建模。作者表明紫杉醇比博莱霉素-长春新碱或依托泊苷更有效，可使人均预期寿命延长4.2年。此外，紫杉醇将是最具成本效益的策略（与博莱霉素-长春新碱相比，每年节省生命的增量成本效益比为380美元），并将保持成本效益
Kaposi sarcoma is one of the most common cancers in sub-Saharan Africa and is associated with substantial morbidity and mortality. 1 Kaposi sarcoma is caused by the Kaposi’s sarcoma herpesvirus. Although Kaposi sarcoma was recognised in endemic form before the HIV epidemic, HIV has driven an epidemic, AIDS-associated form of the disease. 2Given the occurrence of Kaposi sarcoma in marginalised communities, research has been chronically underfunded. However, the preferred firstline therapies for advanced stage Kaposi sarcoma in high-income countries, where costs of therapy are infrequently the limiting factor, are pegylated liposomal doxorubicin (PLD) or paclitaxel. 3 In sub-Saharan Africa, long-term, prospective data on Kaposi sarcoma outcomes is scarce, although recent studies have improved our understanding of chemotherapy responses. 4, 5 Specifically, a recent AIDS Clinical Trials Group and AIDS Malignancy Consortium trial, 4 done across sites in Kenya, Malawi, Uganda, South Africa, Zimbabwe, and Brazil, randomly assigned participants with advanced Kaposi’s sarcoma to paclitaxel, bleomycin–vincristine, or etoposide. The primary outcome was progression-free survival (PFS) at 48 weeks. Paclitaxel was superior (48-week PFS 64%) to bleomycin–vincristine (44%) and etoposide (20%). To our knowledge, there is no randomised prospective data on PLD in sub-Saharan Africa, 6 although a randomised controlled trial is planned by the AIDS Malignancy Consortium. Despite the clinical superiority of paclitaxel, implementation of paclitaxel has been slow. In this issue of TheLancet Global Health, Esther Freeman and colleagues7 employ published clinical data from sub-Saharan Africa and costing data from Kenya to model the cost-effectiveness of four chemotherapy regimens (ie, PLD, etoposide, bleomycin–vincristine, and paclitaxel). The authors showed that paclitaxel would be more effective than bleomycin–vincristine or etoposide and would increase life expectancy by 4· 2 years per person. Furthermore, paclitaxel would be the most cost-effective strategy (incremental cost-effectiveness ratio of US $380 per year-of-life-saved compared with bleomycin-vincristine) and would remain cost-effective