Pharmacoeconomic Study Of Three Chemotherapy Regimens For Metastatic Pancreatic Cancer

ObjectivesBased on the principles and methods of pharmacoeconomics,a Markov model was constructed to evaluate three first-line chemotherapy regimens for metastatic pancreatic cancer:FOLFIRINOX(5-fluorouracil,leucovorin,irinotecan,and oxaliplatin),AG(gemcitabine+nab-Paclitaxel)and GS(gemcitabine+tegafur),so as to provide references for Chinese clinical workers and patients with advanced pancreatic cancer For reference.Methods(1)Selection of model parameters:according to the drug price of the Second Affiliated Hospital of Zhengzhou University,calculate the cost of drug treatment of three treatment schemes.The incidence of adverse reactions,cost of adverse reactions and second-line treatment rate all refer to foreign large-scale clinical randomized controlled trials.At the same time,according to the efficacy indicators in clinical trials and the principle of deale method,the probability of three treatment schemes transferring from one disease state to another is estimated.Health utility values were determined by referring to clinical trials of Attard et al.(2)Establishment of Markov model:Use Treeage Pro 2011 software to establish Markov model decision tree.Three disease states for metastatic pancreatic cancer were determined:progression-free survival,progression,and death.The Markov model cohort analysis method was used to simulate the probability and cost of patients with metastatic pancreatic cancer in different states after 5 years.The analysis results were corrected by 5%discount and half-circle correction,and the cost-effectiveness analysis of the three treatment plans was performed in conjunction with the cohort simulation results.(3)Sensitivity analysis:?Single-factor sensitivity analysis:Analyze the degree of influence of each model parameter on the cost-effectiveness comparison result,and the result is represented by a cyclone graph.?Probabilistic sensitivity analysis:The MonteCarlo simulation method was used for evaluation.Each time 10,000 people were simulated,a total of 1,000 simulations were performed,and 1,000 Markov cohorts were obtained,and the results are represented by scatter diagram.Result(1)Cohort analysis:After 5 years cycle of the model,the mortality rates of FX,AG,and GS are 99.998%,99.656%,and 99.99%,the cumulative costs are 92066.18105 yuan,143236.2361 yuan,and 85172.41137yuan,respectively,and the cumulative quality adjusted life months are 5.18326qalms,6.3824qalms and 5.31258qalms.The cost of the FX scheme is higher than that of the GS scheme,but the QALMs obtained are less than the GS scheme,so there is no cost-effectiveness benefit.The effectiveness of the AG scheme is high,but its cost is significantly higher than that of the GS scheme.(2)Cost effect analysis:the life quality of GS plan is 16040 yuan per month;FOLFIRINOX plan is 17773.39 yuan per month;AG plan is 22450.82 yuan per month.The volume cost-effectiveness ratio(ICER)of FOLFIRINOX and GS solutions is negative(-53029),which is an absolute disadvantage,while the cost-effectiveness ratio(ICER)of AG and GS solutions is positive(54265.25).Since the willingness payment set in this study is 17,723 yuan,the GS plan is the preferred plan.(3)Sensitivity analysis:Single factor sensitivity and probability sensitivity analysis:Compared with AG solution,the result of FOFFIRINOX plan is more stable,and the parameters have little effect on the results.Compared with the GS plan,the result of the FOLFIRINOX plan is not very stable,and the parameters have a little effect on the results.Compared with the GS plan,the AG plan has more stable results,and the parameters have little effect on the results.In the WTP range,the net benefit acceptance curve shows that GS is the optimal plan.ConclusionAccording to the pharmacoeconomic evaluation process,this study initially established a Markov model to evaluate the treatment plan of metastatic pancreatic cancer.GS chemotherapy plan may be more cost-effective than FX and Ag.This suggestion should be considered in the clinical practice of pancreatic cancer.In addition,due to the poor prognosis of patients with advanced pancreatic cancer,it is of great clinical significance to establish a model of treatment progress.It can further optimize the utilization of medical resources,at the same time,provide research ideas and analysis steps for the same type of research,and promote the development and progress of clinical research.