基于真实世界的3种止吐方案预防含顺铂多日化疗相关恶心呕吐的成本-效用分析

周雪莹 张策 方丽萍 李娜 于佳 王颖 王宇

中圖分类号 R956 文献标志码 A 文章编号 1001-0408（2021）20-2509-05

DOI 10.6039/j.issn.1001-0408.2021.20.12

摘 要 目的：为临床化疗所致恶心呕吐（CINV）相关用药决策提供参考。方法：通过医院信息系统收集2020年1-12月在我院确诊为恶性肿瘤并进行含顺铂多日化疗患者的病例资料，按5-羟色胺3受体拮抗剂用药方案的不同分为托烷司琼组、雷莫司琼组和帕洛诺司琼组;采用倾向评分匹配法均衡3组方案的协变量，对匹配后的3种止吐方案进行成本-效用分析，并进行单因素敏感性分析和抽样不确定性分析。结果：成本-效用分析结果显示，在1个观察周期内，托烷司琼方案的治疗成本为237.71元，效用为0.054 68质量调整生命年（QALYs）;雷莫司琼方案的治疗成本为242.37元，效用为0.055 26 QALYs;帕洛诺司琼方案的治疗成本为319.24元，效用值为0.055 76 QALYs。帕洛诺司琼方案相比托烷司琼方案的增量成本-效果比（ICER）为75 155.69元/QALY，帕洛诺司琼方案相比雷莫司琼方案的ICER为152 062.07元/QALY，均低于3倍我国2020年人均国民生产总值（217 341元/QALY）。敏感性分析和抽样不确定性分析的结果均提示基础分析的结果比较稳定。结论：在目前的药品价格下，对于含顺铂多日化疗所致CINV的预防，以帕洛诺司琼为基础的止吐方案更具经济性。

关键词 顺铂;多日化疗;化疗所致恶心呕吐;5-羟色胺3受体拮抗剂;托烷司琼;雷莫司琼;帕洛诺司琼;成本-效用分析;真实世界

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，FANG 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.