背景:三阴性乳腺癌(TNBC)导致10-20%的乳腺癌病例,并导致医疗保健成本上升。因此,需要进行健康经济评估,以联系临床结果和治疗方案的成本,并从健康经济角度提出行动建议.
方法:我们通过应用效率前沿方法研究了德国转移性TNBC批准治疗方案的成本效益比。这些包括sacituzumab-govitecan(SG),eribulin,长春瑞滨,和卡培他滨.根据症状恶化时间(TSW),以(i)中位总生存期(mOS)和(ii)与健康相关的生活质量(HRQoL)来衡量临床获益。为了评估医疗福利,文献在PubMed中对(I)和(II)进行了系统综述,分别。从法定医疗保健支付者的角度考虑年度直接门诊治疗费用,计算治疗费用。这是为了两者,(i)及(ii),产生效率前沿。
结果:每年直接门诊治疗费用为176,415.21欧元(SG),47,414.14欧元(eribulin),13,711.35欧元(长春瑞滨),和3,718.84欧元(卡培他滨)。对(i)的系统文献回顾和统计分析得出的OS值为14.3、9.56、9.44和7.46个月,分别。卡培他滨,长春瑞滨,和SG是包括操作系统在内的效率前沿的一部分。长春瑞滨的每额外费用最高的额外收益是确定的,其次是SG。对(ii)的系统评价显示,没有接受长春瑞滨的TNBC患者的TSW数据可用,防止出现包括HRQoL在内的效率边界。
结论:长春瑞滨最具成本效益,其次是SG。健康经济评估支持决策者评估一个适应症区域内的治疗方案。在德国,效率边界可以为创新干预措施的定价提供决策支持。因此,我们的分析结果可以指导报销的确定。
BACKGROUND: Triple-negative breast cancer (TNBC) is responsible for 10-20% cases of breast cancer and is resulting in rising healthcare costs. Thus, health-economic evaluations are needed to relate clinical outcomes and costs of treatment options and to provide recommendations of action from a health-economic perspective.
METHODS: We investigated the cost-benefit-ratio of approved treatment options in metastatic TNBC in Germany by applying the efficiency frontier approach. These included sacituzumab-govitecan (SG), eribulin,
vinorelbine, and capecitabine. Clinical benefit was measured as (i) median overall survival (mOS) and (ii) health-related quality of life (HRQoL) in terms of time to symptom worsening (TSW). To assess medical benefits, literature was systematically reviewed in PubMed for (i) and (ii), respectively. Treatment costs were calculated considering annual direct outpatient treatment costs from a statutory healthcare payer perspective. It was intended that both, (i) and (ii), yield an efficiency frontier.
RESULTS: Annual direct outpatient treatment costs amounted to EUR 176,415.21 (SG), EUR 47,414.14 (eribulin), EUR 13,711.35 (vinorelbine), and EUR 3,718.84 (capecitabine). Systematic literature review of (i) and statistical analysis resulted in OS values of 14.3, 9.56, 9.44, and 7.46 months, respectively. Capecitabine,
vinorelbine, and SG are part of the efficiency frontier including OS. The highest additional benefit per additional cost was determined for
vinorelbine, followed by SG. Systematic review of (ii) revealed that no TSW data of TNBC patients receiving
vinorelbine were available, preventing the presentation of an efficiency frontier including HRQoL.
CONCLUSIONS: Vinorelbine is most cost-effective, followed by SG. Health-economic evaluations support decision-makers to assess treatment options within one indication area. In Germany, the efficiency frontier can provide decision support for the pricing of innovative interventions. Results of our analysis may thus guide reimbursement determination.