| ObjectiveMultiple Myeloma(MM),the second most common hematologic malignancy,is incurable.The main purpose of clinical treatment is to prolong the survival time of patients.The benefits of traditional chemotherapy regimens in the treatment of MM patients were limited,and the median survival time of MM patients is generally not more than 3 years.Bortezomib,a kind of good targeted therapy,can significantly improve the overall survival and progression free survival of patients with MM.However,its relatively high costs caused a huge economic burden,so its application in patients with indications is limited.Therefore,the objective of this study was to explore the efficacy and pharmacoeconomic value of bortezomib.MethodAll patients with primary multiple myeloma,which were in accordance with the inclusion/exclusion criteria,were selected as the research object from a certain Grade A of Level 3 Hospital from January 2011 to December 2015 in Shenyang.The patients'baseline data,treatment data and medical expenses were collected through the hospital medical record system.Patients were divided into bortezomib group and traditional chemotherapy group according to whether the chemotherapy regimen included bortezomib.SPSS 22.0 was used to make statistical analyses.According to the type of baseline data,?2-test or z-test were used to compare the results.The curative effect was compared with Wilcoxon rank-sum test.The overall response rate,response rate and the incidence of adverse reactions were compared with ?2-test.The curative effect of each group was analysed by the generalized estimating equation.The laboratory indexes were compared by repeated measurement analysis of variance.Results1.This study included 128 patients with MM,of which 42 cases were in bortezomib group and 86 in the traditional chemotherapy group.The average age of the patients was 59.30 ± 10.02 years(bortezomib group is 60.24 ± 11.29 years old,traditional chemotherapy group is 58.83 ± 9.37 years old).The sex ratio(male/female)was 1.2:1(bortezomib group was 1.2:1,the traditional treatment group was 1.3:1).:There were no significant differences in age,gender,DS stage,ISS stage and type of renal function between two groups(P>0.05).2.The effect of bortezomib group were better than traditional chemotherapy group;after 2 circles of treatment,the complete response rate of bortezomib in patients with bortezomib,the overall response rate is higher than the traditional chemotherapy group(40.5%vs 12.8%,P<0.001;95.2%vs 73.3%,P=0.003);after 3 circles of treatment,the complete response rate and the very partial response rate of bortezomib group were higher than that of conventional chemotherapy group(45.2%vs 14%,P<0.001;85.7%vs 61.6%,P=0.005);after 4 circles of treatment,the complete response rate and the very partial response rate of bortezomib group were higher than that of conventional chemotherapy group(45.2%vs 19.8%,P=0.003;85.7%vs 62.8%,P=0.008);bortezomib can better increase hemoglobin,erythrocyte count,and albumin and decrease serum ?2-microglobulin,serum creatinine and urinary ?2-microglobulin than conventional chemotherapy.3.The incidence rate of neutropenia in bortezomib group was lower than the traditional chemotherapy group(14.3%vs2.3%,P=0.028),the incidence rate of peripheral neuropathy was higher than the conventional chemotherapy group(31.0%vs2.3%,P<0.001),the differences were significant.There were no significant difference in the incidence of other adverse events between two groups.4.There were significant differences in the cost of each circle of treatment between two groups(P<0.05)and there were significant differences between circles in each group(P<0.05).The top five expenses of two groups are both drugs,laboratory fees,examination fees,bed fee and treatment fee.5.A unit of complete rate,very good partial rate,overall response rate,and clinical benefit rate respectively need 3221.62 yuan,1767.96 yuan,1370.54 yuan,and 1475.97 yuan,were higher than the conventional chemotherapy group,of which were 1178.54 yuan,383.90 yuan,309.31 yuan,and 227.65 yuan.Incremental cost effectiveness ratio were respectively 3888.46,7428.29,4986.58,and 9285.36.The sensitivity analysis show the same results.Conclusion1.The bortezomib-based chemotherapy is more effective than traditional chemotherapy regimens,and has a more positive effect on improving patients'biochemical indicators.2.There were no significant differences in the incidence of most adverse events between two groups so that bortezomib can be well tolerated.3.The cost of the chemotherapy regimen based on bortezomib was higher than that of the traditional chemotherapy regimen,the main cause of the higher cost of treatment is the expense for medicine.4.From the cost-effectiveness analysis,the ratio of cost-effectiveness of traditional chemotherapy is relatively low.It is suggested that patients with poor economic capacity use conventional chemotherapy and patients with better economic ability adopt chemotherapy regimens based on bortezomib in order to get faster and maintain good therapeutic effect. |
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