The Cost-effectiveness Analysis Of Two Therapeutic Regimens In Patients With Newly Diagnosed Multiple Myeloma

Objiective:Multiple myeloma is the second most common malignant tumor of the hematological system,which is still incurable.the choice of the therapeutic regimens with the disease must conform to the principle of clinical rational drug use,and Parmacoeconomics can guide clinical rational drug use.From the study perspective of patients,through cost-effectiveness analysis(CEA),compared bortezomib plus cyclophosphamide versus dexamethasone(BCD)with thalidomide plus cyclophosphamide versus dexamethasone(TCD)with pharmacoeconomic evaluation in the treatment of newly diagnosed multiple myeloma.The purpose of this study was to compare the economy of two regimens,guide the clinicial drug use,and provide reference for clinical rational drug use.Method:According to the include and exclusion criteria,the newly diagnosed multiple myeloma patients were selected as the research object in the third hospital of hebei medical university on January 1,2015 to March 1,2017.According to the treatment protocols,patients divided into BCD and TCD.The follow-up period was 6 months,including 36 patients,11 patients for BCD and 25 patients for TCD.SPSS 22.0 was used to analyze the baseline data and medical cost of the two regimens.The markov model was established and Treeage Pro 2011 software was used,by setting up those parameters,such as the model of probability,utility,cost,discount rate,simulation time is set to 20 years,simulation cycle for a month,cost effect analysis was carried out on the two regimens.Cost-effectiveness analysis' s observation indexes is quality adjusted life month(QALMs),and analysised results of the study with sensitivity analysis,to compared long-term cost-effectiveness of BCD with TCD in NDMM patients.Result:1 Cost-effectiveness analysis was carried out on the BCD and TCD.The incremental cost is 749362 yuan,and the incremental effectiveness is 67.50 QALM.The ICER value is 11101 yuan /QALM,which is lower than the cost-effectiveness threshold of 14,876 yuan.It can be seen that the BCD is within the acceptable range of patients.2 The one way sensitivity analysis of the BCD arm and TCD arm can be seen that the total medical cost of bortezomib is the biggest influence factor on the results,and the other factors are small.3 The probabilistic sensitivity analysis was carried out on the BCD arm and TCD arm,in the WTP value reach 14876 yuan,the incremental cost-effectiveness scatter plot shows that the probability of BCD arm can be accepted by patients was 53.8%,the probability of TCD arm can be accepted by the patients was 46.2%;The cost-effectiveness acceptability curve can be seen that,when the WTP value is 14,876 yuan,the probability of the BCD arm can be accepted by the patients was about 55.4%.Conclusion:1 Compared with TCD scheme,BCD scheme is more cost-effectiveness in the treatment of patients with multiple myeloma,which is worthy of clinical promotion,and provides reference for the clinical rational use of multiple myeloma.2 This study has the limit of less sample size and short follow-up period,it needs more center and enlarge sample size for further research on the real world research in order to obtain more accurate results.