- 學位論文
探討轉移性大腸直腸癌病人以UGT1A1基因型態提高bevacizumab合併irinotecan劑量之成本效用分析
Cost-effectiveness analysis of using the UGT1A1 genotype to increase irinotecan dose plus bevacizumab for metastatic colorectal cancer
摘要
研究目的：大腸直腸癌於全國發生率排名第四名，死因排名第二名；在台灣地區，每十萬人口就有15.09人因大腸癌而死亡。人體基因中的UGT1A1型態，有些會影響其功能或表現量，進而影響Irinotecan的使用療效。因此本研究想了解透過基因檢測後給予不同劑量的Irinotecan是否可以延長病人存活時間、不影響病人生活品質並且具有成本效用。研究方法：本研究為前瞻性及回溯性研究，收案期間為2015年10月至2018年4月，共134位受試者。蒐集其治療前、治療後六個月及治療後一年之相關生活品質問卷，並蒐集期間直接住院成本，運用決策樹進行成本效用分析。研究結果：本研究Irinotecan標準劑量組81位病患(60.5 %)，提高劑量組53位病患(39.6%)，平均年齡58.1歲及60.6歲。標準劑量組在6個月時提供0.32的QALYs要花費台幣696,464元，提高劑量組提供0.42的QALYs要花台幣833,117元，ICER值為1,481,899 /QALY；在治療後12個月，標準劑量組提供0.56的QALYs要花費台幣886,404元，提高劑量組提供0.79的QALYs要花台幣1,125,038元，ICER值為1,031,501/QALY，在WTP(Willingness-To-Pay)為2個GDP之下，提高劑量具有成本效用。結論與建議：研究結果顯示，透過基因檢測給予不同劑量之irinotecan具有較好之成本效用，建議未來在臨床上能鼓勵病人藉由基因檢測，了解自己基因情況，進而給予適當劑量獲得更好療效。
並列摘要
Purpose: Colorectal cancer incidence rate rank is fourth and death rate ranks is second in the national. In Taiwan, per 100,000 people have 15.09 people die due to colorectal cancer. The UGT1A1 in human genes, and some may affect their function or performance. The amount, which in turn affects the efficacy of irinotecan. Therefore, this study wanted to know whether different doses of irinotecan after genetic testing can prolong the survival of patients without affecting the quality of life of patients and cost-effectiveness.Methods: This study was a prospective and retrospective study with a total of 134 subjects between October 2015 and April 2018. The relevant quality of life questionnaires were collected before treatment, six months and one year after treatment, and the direct hospitalization costs were collected during the period, and the decision tree was used for cost utility analysis. Results: In this study, 81 patients (60.5%) in the Irinotecan standard dose group and 53 patients (39.6%) in the elevated dose group, with an average age of 58.1 years and 60.6 years. The standard dose group will cost NT$696,464 for the QALYs of 0.32 at 6 months, and the QALYs for the 0.42 increase in the dose group will cost NT$833,117 and the ICER value of 1,481,899/QALY; the standard dose group will provide 0.56 at 12 months after treatment. The QALYs cost NT$886,404, and the QALYs for the 0.78 increase in the dose group cost NT$1,125,038 and the ICER value is 1,031,501/QALY. Under the WTP (Willingness-To-Pay) of 2 GDP, it is cost-effective to increase the dose. Conclusion: The results of the study show that different doses of irinotecan are more cost-effective through genetic testing. It is recommended that patients in the future be encouraged to use genetic testing to understand their genetic status and then give appropriate doses for better results.
參考文獻
延伸閱讀
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