四种不同化疗方案在侵蚀性葡萄胎患者中的疗效比较及药物经济学评价

目的:观察4种不同的化疗方案对侵蚀性葡萄胎的疗效并进行物经济学比较。方法:回顾性分析2014年01月至2017年01月我院收治的侵蚀性葡萄胎患者76例,分为甲氨蝶呤(MTX)组、EMA-CO组、新福菌素组(ACT)、5-氟尿嘧啶(5-Fu)+新福菌素组,观察4组患者治疗后的疗效、安全性,并采用成本-效果分析方法进行药物经济学分析。结果:4组患者在年龄、治疗花费、疗效间没有差异。MTX组药费最低(5876.5±644.9元,P0.01),成本-效果比最低(286.74元),但MTX组的化疗的副反应(骨髓抑制)发生率最高;其他三组同MTX组相比,其增量成本-效果比均2000元。联合化疗方案中,EMA-CO较5-Fu+ACT组药费较低(36027.2±1792.2元vs 60215.2±3632.8元,P0.01),增量成本效果优势明显(2542.69元vs 7963.19元)。结论:对于侵蚀性葡萄胎患者,针对患者的不同情况采用联合化疗或单药化疗,其疗效均无显著性差异。MTX组治疗花费最为经济,其他组增量成本-效果较高,考虑到副反应发生率、住院天数等其他因素,其他三组仍有选择优势。

Clinical Curative Effects and Pharmacoeconomics Evaluation of Four Different Chemotherapy Regimens in Invasive Mole Patients

ABSTRACT Objective: To comparative clinical curative effects and pharmacoeconomics evaluation of four different chemotherapy regimens with invasive mole. Methods: Retrospective analysis were used to analyzed 76 cases of invasive mole patients enrolled from January 2014 to January 2017 in hospital. Patients were divided into four groups: methotrexate, actinomycin, EMA-CO, 5-Fu+ actinomycin. The clinical curative effects, pharmacoeconomics evaluation and side effect of the four groups were analyzed. Results: There were no difference in age, treatment expenses and clinical curative effects of the four groups. The MTX group had lowest medicine expenses(5876.5±644.9 yuan, P<0.01), cost-effectiveness ratio (286.74 yuan) and highest side effect(myelosuppression). The incremental cost-effectiveness ratios were all more than 2000 yuan in the other three groups compared with MTX group. EMA-CO group had lower medicine expenses compared with 5-Fu+actinomycin group(36027.2±1792.2 yuan vs 60215.2±3632.8 yuan, P<0.01) in combined chemotherapy regimens, and the EMA-CO group also had obvious advantage on incremental cost-effectiveness ratio(2542.69 yuan vs 7963.19 yuan). Conclusion: For invasive mole patients, different chemotherapy regimens had similar clinical curative effects. MTX group had lowest medicine cost, while the other three groups had lower incremental cost-effectiveness ratio. The other three groups also still had advantages considering lower incidence rates of side effect and hospital day.