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王银华

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学术前沿

他莫昔芬预防乳腺癌经济、有效

发表者:王银华 2265人已读

最近发表在美国癌症协会(American Cancer Society)的同行评审期刊《癌症》(Cancer)上的一项研究指出,用来预防乳腺癌的他莫昔芬(tamoxifen)具有很高的成本获益,对于具有乳腺癌高危风险且年龄低于55岁的绝经后女性来说,他莫昔芬预防癌症的益处足以补偿其副作用。芜湖市第二人民医院肿瘤放疗科王银华

研究表明,他莫昔芬可以在治疗结束后连续多年预防乳癌,但是,最大的挑战在于找出哪些女性群体的获益最大,同时不会经受严重的副作用。这种药的副作用包括肺栓塞、子宫内膜癌、深静脉血栓和白内障,以及潮红和更年期提前。

研究者利用数学模型在一项虚拟临床试验中模拟低于55岁的绝经后人群,对比接受他莫昔芬治疗和不接受治疗的效果。在对四种随机、安慰剂、对照癌症预防试验进行分析的基础上,研究人员对他莫昔芬疗法进行建模,并评估了治疗结束后他莫昔芬对女性乳癌风险的10年预防作用。

研究发现,在55岁及以下的绝经后女性中,5年间发生乳癌的风险率为1.66%或更高,他莫昔芬对这些人的疗效最好,而副作用最低。在这组女性中,服用他莫昔芬来预防乳癌可以挽救生命,同时产生副作用的频率也较低,并且还可以节省医疗费用。

Keywords:

  • tamoxifen;
  • breast cancer;
  • chemoprevention;
  • cost-effectiveness

Abstract

BACKGROUND:

Previous cost-effectiveness analyses of tamoxifen therapy account for breast cancer risk reduction during active treatment but not for its persistent protective effect after active treatment.

METHODS:

A detailed, continuous time, mathematical model of breast cancer and healthcare processes was used to simulate a postmenopausal population aged <55 years in a virtual trial comparing tamoxifen treatment with no treatment for lifetime follow-up. Unlike previous work, the current model of tamoxifen therapy is based on a meta-analysis of 4 randomized, placebo-controlled chemoprevention trials with breast cancer risk reduction continuing for 10 years after treatment termination. Cancer incidence and survival data were derived from Surveillance, Epidemiology and End Results statistics. Noncancer disease incidences, quality-adjusted life year (QALY) utility weights, and costs were derived from the literature.

RESULTS:

Tamoxifen treatment (vs no treatment) saved 29 QALYs in a population of 1000 postmenopausal women aged <55 years with an additional cost of $333,000 over the population's lifetime (average cost-effectiveness ratio, $11,530 per QALY). Tamoxifen therapy, compared with no treatment, was cost saving when higher risk populations were targeted (5-year risk ≥1.66%). The cost-effectiveness results were sensitive to parameters that characterized menopausal symptoms and adverse side effects of tamoxifen.

CONCLUSIONS:

The current results indicated that tamoxifen chemoprophylaxis for postmenopausal women aged <55 years is a cost-effective health policy that reduces breast cancer incidence and improves life expectancy. Focusing on a postmenopausal population aged <55 years minimized the threat of adverse events associated with tamoxifen. Cancer 2011. © 2011 American Cancer Society.

 

from  univadis

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发表于:2011-04-02 00:23

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