基于真實世界的3種止吐方案預防含順鉑多日化療相關惡心嘔吐的成本-效用分析

周雪瑩 張策 方麗萍 李娜 于佳 王穎 王宇

中圖分類號 R956 文獻標志碼 A 文章編號 1001-0408（2021）20-2509-05

DOI 10.6039/j.issn.1001-0408.2021.20.12

摘 要 目的：為臨床化療所致惡心嘔吐（CINV）相關用藥決策提供參考。方法：通過醫(yī)院信息系統(tǒng)收集2020年1-12月在我院確診為惡性腫瘤并進行含順鉑多日化療患者的病例資料，按5-羥色胺3受體拮抗劑用藥方案的不同分為托烷司瓊組、雷莫司瓊組和帕洛諾司瓊組;采用傾向評分匹配法均衡3組方案的協(xié)變量，對匹配后的3種止吐方案進行成本-效用分析，并進行單因素敏感性分析和抽樣不確定性分析。結果：成本-效用分析結果顯示，在1個觀察周期內，托烷司瓊方案的治療成本為237.71元，效用為0.054 68質量調整生命年（QALYs）;雷莫司瓊方案的治療成本為242.37元，效用為0.055 26 QALYs;帕洛諾司瓊方案的治療成本為319.24元，效用值為0.055 76 QALYs。帕洛諾司瓊方案相比托烷司瓊方案的增量成本-效果比（ICER）為75 155.69元/QALY，帕洛諾司瓊方案相比雷莫司瓊方案的ICER為152 062.07元/QALY，均低于3倍我國2020年人均國民生產總值（217 341元/QALY）。敏感性分析和抽樣不確定性分析的結果均提示基礎分析的結果比較穩(wěn)定。結論：在目前的藥品價格下，對于含順鉑多日化療所致CINV的預防，以帕洛諾司瓊為基礎的止吐方案更具經濟性。

關鍵詞 順鉑;多日化療;化療所致惡心嘔吐;5-羥色胺3受體拮抗劑;托烷司瓊;雷莫司瓊;帕洛諾司瓊;成本-效用分析;真實世界

Cost-utility Analysis of 3 Antiemetic Regimens to Prevent Nausea and Vomiting Caused by Multi-day Cisplatin-containing Chemotherapy Based on the Real World

ZHOU Xueying1，ZHANG Ce1，F(xiàn)ANG Liping2，LI Na2，YU Jia1，WANG Ying1，WANG Yu1（1. Dept. of Pharmacy， Second Affiliated Hospital of Dalian Medical University， Liaoning Dalian 116023， China; 2. Dept. of Oncology， Second Affiliated Hospital of Dalian Medical University， Liaoning Dalian 116023， China）

ABSTRACT? ?OBJECTIVE： To provide reference for clinical decision-making related to chemotherapy-induced nausea and vomiting （CINV）. METHODS： The medical records of patients diagnosed as malignant tumor receiving multi-day cisplatin-containing chemotherapy in our hospital were collected by hospital information system from Jan.-Dec. 2012. The medical records were divided into tropisetron group， ramosetron group and palonosetron group according to different schemes of 5-hydroxytryptamine-3 receptor antagonist. The covariates of 3 groups were balanced by propensity score matching method; cost-utility analysis was conducted for the 3 matched antiemetic schemes; one-way sensitivity analysis and sampling uncertainty analysis were also conducted. RESULTS： The results of cost-utility analysis showed that treatment cost of one observation period of tropisetron group was 237.71 yuan and utility were 0.054 68 QALYs; that of ramosetron group was 242.37 yuan and utility were 0.055 26 QALYs， and that of palonosetron group was 319.24 yuan and utility were 0.055 76 QALYs. Compared with tropisetron group， the ICER of palonosetron group was 75 155.69 yuan/QALY; Compared with ramosetron group， the ICER of palonosetron group was 152 062.07 yuan/QALY. Both of them were lower than 3 times of Chinas 2020 per capita GDP （217 341 yuan/QALY）. The results of sensitivity analysis and sampling uncertainty analysis demonstrated that the results of basic analysis were robust. CONCLUSIONS： Under the current drug price， the antiemetic regimen based on palonosetron is more economical for the prevention of CINV caused by multi-day chemotherapy containing cisplatin.