摘要
目的从我国卫生体系角度出发,评价信迪利单抗联合化疗一线治疗晚期或复发性非小细胞肺癌(NSCLC)的经济性,为临床用药方案的选择及医疗卫生决策提供依据。方法基于ORIENT-11研究数据建立分区生存模型,以21 d作为模型周期,模拟至99%的患者死亡。以质量调整生命年(QALY)作为产出指标,评价信迪利单抗联合化疗(试验组)对比单纯化疗(对照组)一线治疗晚期或复发性NSCLC的经济性。对成本和效用采用5%的贴现率进行贴现;采用敏感性分析和情境分析验证基础分析结果的稳健性。结果在以3倍2020年我国人均国内生产总值(GDP)作为意愿支付(WTP)阈值的前提下,试验组患者在获得更多效用(0.482 QALY)的同时也需要花费近2倍于对照组的成本,增量成本-效果比(ICER)为334974.41元/QALY。单因素敏感性分析结果显示无进展生存状态效用值、培美曲塞价格、效用贴现率、成本贴现率和信迪利单抗价格对ICER的影响较大。概率敏感性分析结果表明,当WTP阈值为3倍2020年我国人均GDP时,试验组方案具有经济性的概率为6.5%。情境分析结果验证了基础分析结果的稳健性。结论在以3倍2020年我国人均GDP作为WTP阈值的前提下,信迪利单抗联合化疗对比单纯化疗一线治疗晚期或复发性NSCLC不具有经济性。
OBJECTIVE From the perspective of China’s health service system,to evaluate the cost-effectiveness of sintilimab combined with chemotherapy in the first-line treatment of advanced or recurrent non-small cell lung cancer(NSCLC),so as to provide reference for the selection of clinical medication plan and medical and health decision-making.METHODS Based on the ORIENT-11 study data,a partitioned survival model was established,and the model period was 21 days to simulate the death of 99%of the patients.Using quality-adjusted life years(QALY)as an output indicator,the cost-effectiveness of sintilimab combined with chemotherapy(trial group)versus chemotherapy alone(control group)in the first-line treatment of advanced or recurrent NSCLC was evaluated.Cost and utility were discounted using 5%discount rate;sensitivity analysis and scenario analysis were used to verify the robustness of the underlying analysis results.RESULTS Under the premise that 3 times of the per capita gross domestic product(GDP)of China in 2020 was used as the threshold of willingness-to-pay(WTP),the patients in the trial group obtained more utility(0.482 QALY)and also spent nearly twice as much as the control group.The incremental cost-effectiveness ratio(ICER)was 334974.41 yuan/QALY.Univariate sensitivity analysis showed that progression-free survival status utility value,pemetrexed price,utility discount rate,cost discount rate and sintilimab price had a greater impact on ICER.The results of probability sensitivity analysis showed that when the WTP threshold was 3 times of China’s per capita GDP in 2020,the probability of the trial group’s plan being cost-effective was 6.5%.The results of the scenario analysis verified the robustness of the underlying analysis results.CONCLUSIONS On the premise of taking 3 times of China’s per capita GDP in 2020 as the WTP threshold,sintilimab combined with chemotherapy is not cost-effective for first-line treatment of advanced or recurrent NSCLC compared with chemotherapy alone.
作者
高红婷
胡梦雪
贾琳琳
吴方
侯艳红
GAO Hongting;HU Mengxue;JIA Linlin;WU Fang;HOU Yanhong(School of International Pharmaceutical Business,China Pharmaceutical University,Nanjing 211198,China)
出处
《中国药房》
CAS
北大核心
2022年第15期1854-1859,共6页
China Pharmacy
基金
教育部人文社会科学研究一般项目(No.19YJC630183)。
关键词
信迪利单抗
化疗
分区生存模型
非小细胞肺癌
成本-效用分析
sintilimab
chemotherapy
partitioned survival model
non-small cell lung cancer
cost-utility analysis
