透過您的圖書館登入
IP:54.221.110.87
  • 學位論文

探討多發性骨髓瘤藥物組合(Velcade/Thaildomide/Dexamethasone與Velcade /Melphalan/Prednisone)之成本效用分析

Cost-Utility Analysis of Velcade/Thaildomide/Dexamethasone versus Velcade /Melphalan/Prednisone in Multiple Myeloma

指導教授 : 許弘毅
若您是本文的作者,可授權文章由華藝線上圖書館中協助推廣。

摘要


研究目的 多發性骨髓瘤是台灣常見的血癌,近年來許多新藥提高患者的存活率,相對地也增加許多醫療資源耗用,本研究目的乃探討多發性骨髓瘤病人接受常見兩種藥物組合(Velcade+Thaildomide+Dexamethasone, VTD vs. Velcade +Melphalan+Prednisone, VMP)之直接醫療費用與醫療效用,進而評估病人開始接受治療後的8個月內,使用VTD治療相較於VMP治療是否較具有成本效用。 研究方法 針對國內南部兩家醫學中心於2014~2018年新診斷為多發性骨髓瘤且無接受移植治療的病人,利用回溯性追蹤評估病人開始接受兩種不同藥物組合治療(VTD vs. VMP)在8個月內之總醫療費用(Cost)及醫療效用,醫療費用為醫院申報之健保費用,效用(Utility)則由國內外相關文獻模擬分析來評估,醫療效益為品質調整存活年(Quality Adjusted Life Years, QALY),以決策樹模型顯示兩種藥物組合的決策順序,進而評估兩種治療策略之成本效益,以遞增成本效用比(Incremental Cost-Utility Ratio, ICUR)來評估。研究資料以Microsoft Excel軟體建檔,再以統計套裝軟體IBM SPSS 20版及TreeAgePro2017版進行統計分析。 研究結果 共77位符合條件的多發性骨髓瘤病人參與本研究,平均年齡為69.21±9.85歲,男性佔54.5%,在成本效用分析,VTD治療藥物組合較VMP治療藥物組合在8個月內總醫療費用較低(新台幣 952,646元 vs 新台幣1028,312)且具有較高的品質調整存活年(QALY)(Min為8.6 vs 4.18,Max為11.42 vs 5.83),遞增成本效用比(ICUR值)為新台幣-13,538元~ -17,100元/QALY,因此,多發性骨髓瘤病人接受常見治療藥物組合,VTD組較VMP組具有成本效用。 結論 本研究以醫療付費者的觀點(Payer’s Perspective),評估多發性骨髓瘤病人開始接受治療後8個月,使用VTD治療相較於VMP治療更具有成本效用,以提供多發性骨髓瘤病人選擇藥物組合治療的參考依據,並期望藉由本研究結果能提供醫療供給者及衛生主管機關在未來政策規劃上之建議,提升整體醫療資源之配置與運用,減少不必要的浪費及社會成本的付出,進而提升整體醫療照護品質。

並列摘要


Objective Multiple myeloma (MM) is a common hematological cancer in Taiwan. In recent years, many new drugs have been developed to improve patient survival outcome but to increase consumption of medical resources simultaneously. Thus, this study purposed to explore the changing trends of total medical costs and medical effectiveness of two common drug combinations (Velcade+Thaildomide+Dexamethasone, VTD vs. Velcade+Melphalan+Prednisone, VMP) in MM, and to evaluate the cost effectiveness of VTD combination and VMP combination in patients after receiving treatment for 8 months. Methods Retrospective study from two medical centers to evaluate the medical cost (Cost) and quality adjusted life years (QALY) for transplant-ineligible patients with newly-diagnosed multiple myeloma and who receive two different drug combinations (VTD vs. VMP) for 8 months.The decision tree model was used to show the decision sequence of multiple myeloma patients who treatment at 8 months. Direct costs and medical benefits were used to assess the cost-effectiveness of two treatment strategies.The research data was filed with Microsoft Excel software, and then statistical analysis was performed with statistical package software IBM SPSS version 20 and TreeAgePro2017 version. Results This retrospective study included 77 MM patients. Mean age of participants was 69.21years±9.85years, and male accounted for 54%. In the cost-effectiveness analysis, the total medical costs in VTD combination are lower than in VMP combination in the past 8 months of treatment and showed a higher QALY. The ICUR is NTD -13,538~ -17,100/ QALY. Based on the results, VTD combination is more effective than VMP combination in the treatment of MM. Conclusions This study was conducted to evaluate the cost effectiveness of VTD and VMP combination for MM patients after receiving treatment for 8 months from the medical healthcare providers’ perspectives. Results showed that VTD combination is more cost-effective than VMP combination, which may provide clinical reference for medical healthcare providers to choose the drug combination for MM patients.

參考文獻


1. D.Kazandjian, Multiple myeloma epidemiology and survival: A unique malignancy. Semin Oncol, 2016. 43(6): p. 676-681.
2. Rebecca L Siegel , Kimberly D Miller , Ahmedin Jemal, Cancer statistics, 2019. CA
Cancer J Clin, 2019. 69(1): p. 7-34.
3. 癌症登記報告, 105癌登年報. 2016.
4. L. Naymagon , M. Abdul-Hay, Novel agents in the treatment of multiple myeloma: a review about the future. J Hematol Oncol, 2016. 9(1): p. 52.

延伸閱讀