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目的:对非小细胞肺癌(NSCLC)患者进行个体化医疗,分析采用各种检测方法分类诊断后指导靶向治疗的健康结果与经济性。方法:建立决策树模型,分别模拟3组10万名NSCLC患者队列用国内指南推荐的3种间变淋巴瘤激酶(ALK)确诊检测方法(FISH、Ventana IHC和RT-PCR),阳性者使用克唑替尼作为一线治疗,计算5年内发生的医疗成本和获得的健康效果,然后进行成本效果分析;临床和经济学结果的数据主要来源于文献报告。结果:以2014年3倍上海人均GDP为阈值(292 110元人民币),Ventana IHC指导用药组相较PCR组成本更低,效果更好,因此Ventana IHC组处于优势地位;FISH组相较于Ventana IHC组的ICER为1 091 727元/QALY,远大于阈值,故Ventana IHC组比FISH组更具有成本效果。结论:在3种诊断ALK的检测方法中,建议优先将Ventan IHC伴随诊断方法纳入NSCLC靶向治疗的疾病管理方案。
OBJECTIVE: To conduct individualized medical care in patients with non-small cell lung cancer (NSCLC) and to analyze the health outcomes and economics of the targeted therapies guided by various detection methods. Methods: A decision tree model was established and three groups of 100,000 NSCLC patients were enrolled in this study. Three kinds of ALK diagnostic tests (FISH, Ventana IHC and RT-PCR) Zopiclotis as a first-line treatment, medical costs occurred within 5 years and the health effects obtained, and then cost-effectiveness analysis; clinical and economic results of the data mainly from the literature report. Results: Ventana IHC group was in a dominant position with 3 times the Shanghai GDP per capita in 2014 as the threshold (292 110 yuan), and the Ventana IHC-guided drug group had lower cost and better effect than the PCR group. Compared with Ventana The IHC group had an ICER of 1 091 727 yuan / QALY, much larger than the threshold, so the Ventana IHC group was more cost-effective than the FISH group. CONCLUSIONS: Among the three diagnostic methods for the diagnosis of ALK, it is advisable to prioritize the Ventan IHC companion diagnostic approach to disease management in NSCLC targeted therapy.