摘要
目的系统评价吉非替尼的临床价值,促进医疗资源的合理配置。方法计算机检索Pub Med、Embase、Cochrane Library、Medline、中国知网、维普、万方、生物医学文献数据库及卫生经济学数据库有关晚期非小细胞肺癌(NSCLC)患者使用吉非替尼的药物经济学研究文献,检索时间为自建库至2019年11月10日。记录并比较各研究特征和结果;研究的质量采用健康经济研究质量(QHES)问卷进行评估。结果最终筛选出38篇文献进行循证评价,对照方案包括第1,2,3代表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(EGFRTKI)、化学治疗(简称化疗)、安慰剂、最佳支持治疗。使用最多的方法是基于马尔可夫模型的成本-效用分析和基于有效率和无进展生存期的成本-效果分析。所有研究QHES平均得分为(73.53±18.97)分。吉非替尼作为一线化疗后维持治疗药物不具有成本-效用;吉非替尼与同代厄洛替尼及埃克替尼相比,埃克替尼更成本-效果(每单位的ORR或每单位的PFS)更佳,厄洛替尼成本-效果最差,但厄洛替尼与吉非替尼相比更具成本-效用(成本/质量调整生命年);吉非替尼作为EGFR突变的一线治疗方案,其成本-效用不及阿法替尼;各国奥西替尼与吉非替尼或其他EGFR-TKI药物相比,任何用药阶段均不具有经济性。结论从长期治疗目标来看,吉非替尼比化疗更具成本-效用,但不如第2代阿法替尼,与同代药物比较仍有争议。中文文献质量有待提高,各国应酌情制订与本国相适应的效用值与成本效果阈值,以提高经济学评价研究的适用性。
Objective To systematically evaluate the clinical value of gefitinib and promote rational allocation of medical resources.Methods Pub Med,Embase,Cochrane Library,Medline,CNKI,VIP,Wanfang,Biomedical Literature Database and Health Economics Database about the pharmacoeconomic research of gefitinib in patients with advanced non-small cell lung cancer(NSCLC)were searched by computer,and the retrieval time was from inception to November 10,2019.The characteristics and results of each research were recorded and compared;the quality of the research was evaluated using the Quality of Health and Economic Research(QHES)questionnaire.Results Thirty-eight literatures were finally screened for evidence-based evaluation.Control regimens included first,second and third generation epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKI),chemotherapy,placebo,and optimal supportive therapy.The most commonly used methods in these studies were cost-utility analysis based on markov models and cost-effectiveness analysis based on ORR and PFS.The quality of these studies was determined using the QHES tool with an average score of(73.53±18.97)points.According to the results of the study,gefitinib as a first-line post-chemotherapy maintenance treatment was not cost-effective;gefitinib compared to erlotinib and icotinib,icotinib was the more cost effective(ORR per unit or PFS per unit),erlotinib was least cost effective;but erlotinib was more cost effective(cost/quality adjusted life years)than gefitinib.As a first-line treatment for EGFR mutations,gefitinib was less cost-effective than afatinib.In the countries reported in this study,osimertinib was not economical at any stage of administration compared to gefitinib or other EGFR-TKI drugs.Conclusion In terms of long-term treatment goals,gefitinib is more cost effective than chemotherapy,but is less economically efficiency than second-generation afatinib and remains controversial compared with the same generation drugs.The quality of Chinese literature needs to be improved,
作者
戴冰
占美
刘怿晗
徐珽
DAI Bing;ZHAN Mei;LIU Yihan;XU Ting(Department of Clinical Pharmacy,West China Hospital’Chengdu,Sichuarg China 611041;West China Pharmaceutical,University,Chengdu,Sichuag,China 611041)
出处
《中国药业》
CAS
2020年第15期I0001-I0008,共8页
China Pharmaceuticals
关键词
吉非替尼
晚期非小细胞肺癌
药物经济学
循证评价
gefitinib
advanced non-small cell lung cancer
pharmacoeconomics
evidence-based evaluation
