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目的评价表皮生长因子受体突变的晚期非小细胞肺癌一线化疗方案厄洛替尼和吉西他滨+卡铂的成本-效果。方法根据疾病进展情况,确定晚期非小细胞肺癌治疗发展过程分为无进展、进展和死亡3个状态,建立Markov状态转移模型。根据文献资料和当地医院的收费标准确定两种非小细胞肺癌一线化疗方案单周期的成本和效用值;运用R语言估算转移概率。建立Markov决策树进行成本-效果分析,并对结果进行一元敏感度分析和概率敏感度分析。结果厄洛替尼和吉西他滨+卡铂10年的成本分别为202 873.56元和369 632.11元,所获得的健康效果分别为1.35质量调整生命年和1.94质量调整生命年,厄洛替尼与吉西他滨+卡铂比较,增量成本效果比为-279 797.55元/质量调整生命年。结论厄洛替尼方案与吉西他滨+卡铂方案相比增量成本效果比小于意愿支付值,从成本-效果分析角度,厄洛替尼方案为优选方案。
OBJECTIVE: To evaluate the cost-effectiveness of erlotinib and gemcitabine plus carboplatin in the first-line chemotherapy regimens of EGFR mutated advanced non-small cell lung cancer. Methods According to the progress of the disease, it was determined that the development of advanced non-small cell lung cancer was divided into three stages: progression, progression and death, and the Markov state metastasis model was established. The cost and utility of single-cycle chemotherapy regimens for two non-small cell lung cancer patients were determined based on literature and local hospital charges. R language was used to estimate the probability of metastasis. Markov decision tree is constructed for cost-effectiveness analysis, and the results are analyzed by one-dimensional sensitivity and probability sensitivity. Results The costs of erlotinib and gemcitabine + carboplatin for 10 years were 202 873.56 yuan and 369 632.11 yuan, respectively. The health effects obtained were 1.35 years of quality adjusted life and 1.94 years of quality adjusted life. Erlotinib and gemcitabine + Compared with carboplatin, the incremental cost-effectiveness ratio was -279797.55 yuan / mass adjusted life year. Conclusions Erlotinib regimen is less cost-effective than gemcitabine + carboplatin regimen in terms of cost-benefit analysis. Erlotinib regimen is the optimal regimen.