帕博利珠单抗联合化疗一线治疗晚期或转移性食管癌的成本-效用分析
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篇名: 帕博利珠单抗联合化疗一线治疗晚期或转移性食管癌的成本-效用分析
TITLE: Cost-utility analysis of pembrolizumab combined with chemotherapy in the first-line treatment of advanced or metastatic esophageal carcinoma
摘要: 目的 评价帕博利珠单抗联合化疗对比单纯化疗一线治疗晚期或转移性食管癌的经济性。方法从我国卫生体系角度出发,利用三状态分区生存模型对帕博利珠单抗联合化疗对比单纯化疗一线治疗晚期或转移性食管癌进行成本-效用分析。模型模拟时限为患者终生,3周为1个循环周期,生存数据利用KEYNOTE-590研究数据外推得到,成本数据来源于药智网2022年公开挂网中标价格的中位值,其中帕博利珠单抗价格按慈善赠药方案折算后计,效用数据来源于文献,成本和效用均采用5%的贴现率。采用单因素敏感性分析和概率敏感性分析考察模型的稳健性。结果基础分析结果显示,相较于单纯化疗方案,帕博利珠单抗联合化疗方案在食管鳞状细胞癌(ESCC)、程序性蛋白死亡配体1综合阳性得分(PD-L1CPS)≥10分和意向治疗(ITT)亚组患者中的增量成本-效果比(ICER)分别为950528.42、107845.39、315754.56元/质量调整生命年(QALY)。敏感性分析结果验证了基础分析结果的稳健性。结论在我国医疗卫生体系下,以1~3倍我国2021年人均国内生产总值为意愿支付阈值,相较于单纯化疗方案,帕博利珠单抗联合化疗方案在ESCC和ITT亚组患者中不具有经济性,而在PD-L1CPS≥10分亚组患者中具有经济性。
ABSTRACT: OBJECTIVE To evaluate the cost-utility of pembrolizumab combined with chemotherapy versus chemotherapy alone in the first-line treatment of advanced or metastatic esophageal carcinoma. METHODS Cost-utility analysis of pembrolizumab combined with chemotherapy versus chemotherapy alone for advanced or metastatic esophageal carcinoma was conducted by using a three-state partitioned survival model from the perspective of health system in China. The model use d a lifetime simulation time frame with 3 weeks as a cycle. The survival data were extrapolated using KEYNOTE- 590 data;cost data were obtained from the median of 2022 public winning bid on Yaozhi network ,among which the price of pembrolizumab was obtained after discounting by a patient assistance program ;utility data were obtained from the literatures ,and a 5% discount rate was used for both cost and utility. One-way sensitivity analysis and probabilistic sensitivity analysis were also conducted to examine model robustness. RESULTS Analysis of the base case results showed that compared to chemotherapy alone ,the incremental cost-effectiveness ratio (ICER)of pembrolizumab combined with chemotherapy regimens were 950 528.42 yuan/QALY,107 845.39 yuan/QALY and 315 754.56 yuan/QALY for esophageal squamous cell carcinoma (ESCC),programmed deathligand- 1 combined positive score (PD-L1 CPS)≥10 and intention-to-treat population (ITT),respectively. The results of sensitivity analysis verified the robustness of the basic analysis results. CONCLUSIONS Under our healthcare system ,using a threshold of willingness-to-pay of 1-3 times our GDP per capita in 2021,pembrolizumab combined with chemotherapy regimen isn ’t cost-utility compared with chemotherapy alone in the ESCC and ITT subgroups of patients ,while it is cost-utility in the PD-L 1 CPS≥10 subgroup of patients.
期刊: 2022年第33卷第12期
作者: 齐冉,杜桂平,刘旭婷,高胜男,刘国强
AUTHORS: QI Ran,DU Guiping ,LIU Xuting ,GAO Shengnan ,LIU Guoqiang
关键字: 帕博利珠单抗;晚期食管癌;转移性食管癌;一线治疗;药物经济学;成本-效用分析
KEYWORDS: pembrolizumab;advanced esophageal carcinoma ;metastatic esophageal carcinoma ;first-line treatment ;pharmaco-
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