| 摘要: |
| 目的：系统综述乳腺癌患者术后辅助化疗方案成本效用分析的研究现状。方法：计算机检索PubMed、Web of Science Core Collection、CNKI和WanFang Data数据库，搜集国内外公开发表的关于乳腺癌患者术后辅助化疗方案成本效用分析的相关文献，检索时限为建库至2016年7月5日；分别从成本研究、效果指标、阈值和敏感性分析等方面进行分析。结果：共纳入14篇文献。2篇未明确样本数，其余12篇文献合计纳入13574例乳腺癌患者。研究所在地为英国、美国、加拿大、西班牙、法国、伊朗、韩国、泰国及中国。伊朗的研究结果显示，FAC比TAC具有优势，无需计算增量成本效果比，其余13项研究的增量成本效果比介于3114~31346美元/QALY之间（经不同币种换算）。除伊朗的研究认为FAC方案优于TAC方案，其余6项研究均认为TAC方案比FAC方案更具成本效果比；3项研究均认为TC方案优于AC方案；2项研究均认为FEC-D方案优于FEC-100方案；1项研究认为和AC方案相比，AC+P方案并不具有成本效果比，1项研究认为FEC-D化疗方案优于CMF方案、E-CMF/FEC60方案。结论：由于研究角度、研究地区、数据来源以及阈值等不一致，研究结论不能进行推广，但成本-效用分析是评价乳腺癌患者术后辅助化疗方案的有效方法，所以研究结果可加以借鉴。我国现有研究较少，应开展更多、更高质量的相关研究为临床提供证据支持。 |
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| A systematic review of cost-utility analyses of postoperative adjuvant chemotherapy regimens for breast cancers |
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| Abstract: |
| Objective To systematically review published cost-utility analyses (CUAs) of postoperative adjuvant chemotherapy regimens for breast cancer patients. Methods Peer-reviewed papers were systematically obtained through electronic database searches of PubMed, Web of Science Core Collection, CNKI and WanFang Data from inception to July 5, 2016.Data were extracted and summarized from literature. Results A total of 14 papers were included. Involving 13574 patients apart from 2 papers undefined the numbers. Studies were conducted in 10 countries, including Britain, the United States, Canada, Spain, France, Iran, South Korea, Thailand and China. Iran’’s results show that FAC was a dominant option versus TAC in short-term.. The incremental cost effectiveness ratio (ICER) of remaining studies ranged from $3114/QALY to $31346/QALY (constant US$). Six studies show that relative to FAC, TAC is a cost-effective adjuvant chemotherapy regimen, whilst the study in Iran found opposite conclusion. Three studies suggest that TC may be considered cost effective compared with AC. Two studies show Adjuvant FEC-D is a cost-effective alternative to FEC 100. One study suggests based on the WHO’s criterion, the regimen of AC with P versus AC is not cost-effective. The other studies show for the average risk woman aged 40 years, compared with E-CMF/FEC60, the FEC-D is cost-effective. Conclusion CUA has been used internationally to evaluate the cost effectiveness of alternative postoperative adjuvant chemotherapy regimens for breast cancer. Owing to the heterogeneity of study design (e.g. research perspectives, research locations, and data sources),the results from literature reviewed in this study may not be applicable to the Chinese context. High quality research from China are required to provide definite conclusions. |
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