摘要
目的评价晚期非小细胞肺癌二线治疗药物帕博利珠单抗、纳武利尤单抗的经济性。方法基于医疗卫生角度,构建动态Markov模型,模拟至99%患者死亡时,产生的医疗成本和质量调整生命年(Qualityadjusted life years,QALYs)。临床参数来自临床试验和间接比较。成本数据和效用值取自相关网站和已发表的文献。敏感性分析用于评估模型参数的不确定性。结果基础分析结果显示,纳武利尤单抗方案的治疗成本为278634元,获得的QALYs为0.88,帕博利珠单抗方案的治疗成本为232596元,QALYs为0.86,两者的增量成本-效果比(Incremental cost effectiveness ratio,ICER)为2301900元/QALY,均远高于支付阈值(257094元)。单因素敏感性分析显示,药品价格、无进展生存期对ICER的影响较大。结论在当前支付阈值下,纳武利尤单抗较帕博利珠单抗无经济性优势,两者的成本和QALYs值差异不大,药品价格变动极有可能逆转经济性结论。
Objective To evaluate the cost-effectiveness of pembrolizumab and nivolumab as second-line treatments for advanced non-small-cell lung cancer.Methods Based on Chinese health perspective,a Markov model was established for simulation until 99%patients died,and then calculate the costs and quality-adjusted life years(QALYs).Clinical parameters were obtained from clinical trials and indirect comparisons.Costs and utility data were derived from related websites and literature published.Sensitivity analysis was used to assess the uncertainty of the model parameters.Results The basic analysis results showed that nivolumab regimen yielded 0.88 QALYs at an expense of 278634 yuan,while it was 232596 yuan for 0.86 QALYs with pembrolizumab regimen.The incremental cost effectiveness ratio(ICER)for them were 2301900 yuan/QALY,which was higher than the threshold of willingness to pay(257094 yuan).Univariate sensitivity analysis revealed greater impact of drug price and progression-free survival on ICER.Conlusion According to the threshold of willingness to pay,nivolumab has no cost-effectiveness when compared with pembrolizumab.The differences in costs and QALYs between them are not significant.It is highly likely that the change of drug price reverses the economic conclusions.
作者
曾晨欣
朱亚兰
张照伟
张霞
Zeng Chenxin;Zhu Yalan;Zhang Zhaowei;Zhang Xia(Department of Pharmacy,Zhejiang University School of Medicine,Jinhua 321000,China;Department of Medical Oncology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China)
出处
《实用药物与临床》
CAS
2024年第9期648-654,共7页
Practical Pharmacy and Clinical Remedies
基金
浙江省医学会临床科研基金项目(2020ZYC‑B43)
金华市中心医院中青年科研启动基金(JY2020‑2‑14)。
