索拉非尼的成本效益作为一线治疗晚期肝癌

StephenW

European Journal of Gastroenterology & Hepatology:
July 2015 - Volume 27 - Issue 7 - p 853–859
doi: 10.1097/MEG.0000000000000373
Original Articles: Hepatocellular Carcinoma
Cost-effectiveness of sorafenib as a first-line treatment for advanced hepatocellular carcinoma

Zhang, Pengfeia,*; Yang, Yua,*; Wen, Fenga,*; He, Xiaofengb; Tang, Ruileia; Du, Zedongc; Zhou, Jinga; Zhang, Jiana; Li, Qiua

Abstract

Objective: Sorafenib has been shown to significantly improve the overall survival of patients with advanced hepatocellular carcinoma (HCC). This study aimed to assess the cost-effectiveness of sorafenib as a first-line treatment for patients with advanced HCC.

Materials and methods: To carry out the analysis, we collected the data on the efficacy and safety of patients treated with sorafenib from medical records and follow-up of these patients. A Markov model comprising three health states (progression-free survival, progressive disease, and death) was created to simulate the process of advanced HCC. We calculated the data on cost from the perspective of Chinese patients. Sensitivity analyses were also carried out to explore the impact of several essential variables.

Results: Overall, 94 patients with advanced HCC were included in our study: 70 in the Child–Pugh A group and 24 in the Child–Pugh B group. The median overall survival was 8.0 months (95% confidence interval: 7.21–8.50). In general, treatment with sorafenib was estimated to increase costs by $18 251.84 compared with best supportive care, with a gain of 0.18 quality-adjusted life years (QALYs). Thus, the incremental cost-effective ratio was $101 399.11/QALY for sorafenib versus best supportive care. In addition, in patients with Child–Pugh A liver function, the total costs and effectiveness were $20 643.06 and 0.48 QALYs, respectively, whereas in the Child–Pugh class B group, the total costs and effectiveness were $15 844.33 and 0.28 QALYs.

Conclusion: On the basis of the commonly accepted willingness-to-pay threshold ($20 301.00/QALY in China), sorafenib is not a cost-effective option as a first-line treatment for patients with advanced HCC.

StephenW

欧洲胃肠病学和肝病学：
2015年7月 - 27卷 - 第7 - P 853-859
DOI：10.1097 / MEG.0000000000000373
原创文章：肝癌
索拉非尼的成本效益作为一线治疗晚期肝癌

张Pengfeia，*;杨，青进，*;文，Fenga，*;他，Xiaofengb;唐，Ruileia;杜Zedongc;周，紧夹;张，钾钠;李，Qiua

抽象

目的：索拉非尼已显示显著改善治疗晚期肝细胞癌（HCC）的整体存活率。这项研究旨在评估索拉非尼的成本效益作为一线治疗晚期肝癌。

材料和方法：为了进行分析，我们收集了索拉非尼病历治疗的患者的疗效及安全性的数据和随访这些患者。已创建马尔可夫模型包括三个健康状态（无进展生存期，渐进性疾病和死亡）来模拟晚期肝癌的过程。我们从中国患者的角度来计算成本的数据。敏感性分析也进行了探讨几个基本变量的影响。

结果：总体而言，94例晚期肝癌被列入我们的研究：在Child-Pugh分级70 A组和24 Child-Pugh分级B组。中位总生存期为8.0个月（95％置信区间：7.21-8.50）。一般情况下，估计用索拉非尼治疗由18美元251.84与最佳支持治疗相比，增加成本，0.18质量调整生命年（的QALY）的增益。因此，增加的成本效益比率为101美元399.11 / QALY的索拉非尼与最佳支持治疗。此外，患者Child-Pugh分级的肝功能，总的成本和效益共计2000 643.06和0.48的QALY，分别，而Child-Pugh分级B级组，总的成本和效益均15美元844.33和0.28的QALY。

结论：根据普遍接受的意愿到支付门槛（20美元301.00 / QALY在中国）的基础上，索拉非尼是不是一个成本效益的选择作为一线治疗晚期肝癌。