摘要
目的 分析帕博利珠单抗联合化学药物治疗(简称化疗)一线治疗晚期转移性非鳞状非小细胞肺癌(NSCLC)的成本-效果。方法 基于KEYNOTE-189临床试验最新数据,构建3种互斥的健康状态[疾病无进展(PFS)、疾病进展(PD)和死亡]的马尔可夫(Markov)模型,评价帕博利珠单抗联合化疗对比单纯化疗一线治疗晚期转移性非鳞状NSCLC的经济性。根据KEYNOTE-189临床试验的生存曲线和PFS计算转移概率,成本和效用参数参考当地价格和已公开发表的文献,以质量调整生命年(QALY)为主要产出指标计算增量成本-效果比(ICER),并对相关参数进行单因素敏感性分析和概率敏感性分析,考察模型结果的稳健性。结果 帕博利珠单抗联合化疗对比单纯化疗的ICER为506 490.226元,无经济性。单因素敏感性分析结果显示,PFS健康状态效用值、贴现率和帕博利珠单抗价格对ICER影响较大;概率敏感性分析结果显示,基础结果稳定、模型稳健性良好;情景分析结果证实,价格是帕博利珠单抗联合化疗治疗无成本-效果的主要因素。结论 帕博利珠单抗联合化疗对比单纯化疗一线治疗晚期转移性非鳞状NSCLC无经济性,其中价格是主要影响因素。建议我国可通过价格谈判或制订支付价格、集中带量采购、规范临床合理用药等方式来降低帕博利珠单抗价格,以增加其经济性优势。
Objective To analyze the cost-effectiveness of pembrolizumab combined with chemotherapy in the first-line treatment of advanced metastatic non-squamous non-small cell lung cancer(NSCLC).Methods Based on the latest data of KEYNOTE-189 clinical trial,a Markov model of three mutually exclusive health states [progression-free survival(PFS),progressive disease(PD) and death] was constructed to evaluate the economics of pembrolizumab combined with chemotherapy versus chemotherapy alone in the first-line treatment of advanced metastatic non-squamous NSCLC. The probability of metastasis was calculated by the survival curve of KEYNOTE-189 clinical trial data,the cost and utility parameters were derived from local prices and published literature,the incremental cost-effectiveness ratio(ICER) was calculated with the quality-adjusted life year(QALY)as the main output indicator,and one-way sensitivity analysis and probabilistic sensitivity analysis were conducted on the relevant parameters to examine the robustness of the model results.Results The ICER of pembrolizumab combined with chemotherapy versus chemotherapy alone was CNY 506 490. 226,which was not economical. The results of one-way sensitivity analysis showed that the PFS health status utility value,discount rate and the price of pembrolizumab had a greater impact on ICER. The results of probabilistic sensitivity analysis showed that the underlying results were stable and the model was robust. The results of scenario analysis confirmed that the price was the main factor for the cost-effectiveness of pembrolizumab combined with chemotherapy.Conclusion Pembrolizumab combined with chemotherapy is not economical compared with chemotherapy alone in the first-line treatment of advanced metastatic non-squamous NSCLC,in which price is the main influencing factor. It is suggested that China can reduce the price of pembrolizumab through price negotiation or making payment price,centralized procurement with quantity,and standardizing clinical rational drug use,so as to increase
作者
齐冉
刘旭婷
高胜男
刘国强
QI Ran;LIU Xuting;GAO Shengnan;LIU Guoqiang(Department of Pharmacy,The Third Hospital of Hebei Medical University,Shijiazhuang,Hebei,China 050051;Hebei Integrated Pharmaceutical and Health Technology Assessment Society,Shijiazhuang,Hebei,China 050051)
出处
《中国药业》
CAS
2022年第24期106-111,共6页
China Pharmaceuticals
基金
河北省自然科学基金[H2021206407]。
