摘要
目的评估阿贝西利联合氟维司群方案二线治疗激素受体(HR)阳性、人表皮生长因子受体2(HER2)阴性晚期乳腺癌的成本-效果。方法从我国卫生体系角度出发,基于MONARCH 2临床试验的数据,构建动态Markov模型,模拟患者10年的直接医疗成本和质量调整生命年(QALYs),以增量成本-效果比(ICER)评价阿贝西利联合氟维司群对比单用氟维司群治疗HR+/HER2-晚期乳腺癌方案的经济性,并对结果进行敏感性分析。结果阿贝西利联合氟维司群组较单用氟维司群组具有更高的健康获益(5.31 QALYs vs.4.49 QALYs),但总成本较高(591689元vs.462183元),ICER为157934.15元/QALY,低于以2021年我国3倍人均国内生产总值(GDP)作为的意愿支付(WTP)阈值。单因素敏感性分析结果表明,无进展生存期状态下的健康效用值、氟维司群组靶向药物治疗概率、氟维司群组化学药物治疗概率等参数对ICER的影响较大。概率敏感性分析结果表明,当WTP在243000元/QALY(3倍人均GDP)以上时,阿贝西利联合氟维司群的方案更具有经济性的概率逐步上升,最终接近100%,阿贝西利联合氟维司群为更优选的方案。结论与单用氟维司群相比,阿贝西利联合氟维司群方案二线治疗HR+/HER2-晚期乳腺癌具有明显的经济性优势。
Objective To evaluate the cost-effectiveness of abemaciclib plus fulvestrant as second-line treatment for hormone receptor-positive and human epidermal growth factor receptor 2(HER2)-negative advanced breast cancer.Methods From the perspective of Chinese healthcare system,based on the data from the MONARCH 2 clinical trial,a dynamic Markov model was constructed to simulate the lifetime direct medical costs and quality-adjusted life years(QALYs)of patients.Incremental cost-effectiveness ratio(ICER)was used to evaluate the economics of abemaciclib plus fulvestrant and fulvestrant monotherapy for HR+/HER2-advanced breast cancer,and the sensitivity of the results was analyzed.Results Compared with fulvestrant monotherapy,abemaciclib plus fulvestrant group could bring more health benefits(5.31 QALYs vs.4.49 QALYs),but the total cost was higher(591689 yuan vs.462183 yuan),and the ICER was 157934.15 yuan/QALY,which was lower than the threshold of willingness to pay(WTP)based on 3 times per capita gross domestic product(GDP)in 2021.The results of one-way sensitivity analysis showed that parameters such as the health utility value in the progression free survival(PFS)state,the probability of targeted drug therapy in the fulvestrant group,and the probability of chemotherapy in the fulvestrant group had great impacts on the ICER value.The results of probabilistic sensitivity analysis showed that the probability of economic efficiency of abemaciclib plus fulvestrant gradually increased and eventually approached 100%when the WTP threshold exceeded 243000 yuan per QALY.Abemaciclib plus fulvestrant scheme was a prefered therapeutic schedule.Conclusion Abemaciclib plus fulvestrant is more economical as a second-line therapy for HR+/HER2-advanced breast cancer compared with fulvestrant monotherapy.
作者
赵曦
闫茜
李宁
侯春霞
Xi ZHAO;Xi YAN;Ning LI;Chun-Xia HOU(Department of Pharmacy,Changzhi People's Hospital,Changzhi 046000,Shanxi Province,China;Department of Breast Surgery,Changzhi People's Hospital,Changzhi 046000,Shanxi Province,China)
出处
《药物流行病学杂志》
CAS
2023年第11期1259-1266,共8页
Chinese Journal of Pharmacoepidemiology
基金
长治市人民医院临床基础创新研究项目(202101C06)。
