瑞维鲁胺一线治疗高瘤负荷、转移性激素敏感性前列腺癌成本效用分析

Cost-effectiveness analysis of first-line treatment of large-volume, hormone-sensitive metastatic prostate cancer with Rezvilutamide

关键词:  瑞维鲁胺  比卡鲁胺  分区生存模型  成本效果分析  激素敏感性前列腺癌

Key words:  Rezvilutamide  Bicalutamide  Partitioned survival  Cost-effectiveness analysis  metastatic, hormone-sensitive prostate cancer

摘要:

目的：分析瑞维鲁胺（rezvilutamide）联合雄激素对比比卡鲁胺(bicalutamide)联合雄激素一线治疗大容量、转移性激素敏感性前列腺癌的经济性。方法：从我国卫生体系角度出发，基于CHART研究数据使用Excel 2019构建无进展生存（PFS）、疾病进展(PD)和死亡(D)的分区生存模型进行成本-效用分析。循环周期为4周，研究时限为终身，贴现率设定为5%。模型输出主要结果为总成本、质量调整生命年(QALY)和增量成本-效果比（ICER）。对模型中的重要参数进行单因素敏感性分析和概率敏感性分析。结果 基础分析：与比卡鲁胺方案相比，瑞维鲁胺方案QALY增加了2.29，成本增加了51 9025.32元，ICER为22 6379.14元/QALY。单因素敏感性分析结果：PFS状态效用值，瑞维鲁胺成本，贴现率对ICER的影响较大。概率敏感性分析显示：当意愿支付（WTP）高于300000元时，瑞维鲁胺成为优势方案的概率为100%。结论：在1～2倍2021年我国人均GDP的阈值下，比卡鲁胺方案一线治疗大容量、转移性激素敏感性前列腺癌更具有经济性，当WTP在3倍GDP时，瑞维鲁胺方案更具有经济性。

Abstract:

Objective: to evaluate the cost-effectiveness of rezvilutamide plus androgen versus bicalutamide plus androgen in the first-line treatment of high-volume, metastatic, hormone-sensitive prostate cancer. Methods: from the point of view of our health system, the cost-utility analysis was carried out by using Excel 2019 to construct the zonal survival models of PFS, PD and D based on the CHART data. The cycle was 4 weeks, the duration of the study was life-long and the discount rate was set at 5 per cent. The main outputs were total cost, quality-adjusted life year (Qaly) and incremental cost-effectiveness ratio (ICER) . Single factor sensitivity analysis and probability sensitivity analysis were carried out for the important parameters in the model. Results, basic analysis: compared with the bicalutamide regimen, the revelutamide regimen increased Qalys by 2.29 yuan, increased costs by 519025.32 yuan, and had an ICER of 226379.14 yuan per QALY. Univariate sensitivity analysis showed that PFS status utility, cost of revelopram, and discount rate had significant effects on ICER. The probability sensitivity analysis showed that when WTP was higher than 300000 yuan, the probability of revelutamide becoming the dominant scheme was 100% . Conclusions: Under the threshold of 1 ~ 2 times of China 's per capita GDP in 2021, it is more economical than the first-line treatment of large-capacity, metastatic hormone-sensitive prostate cancer with carlutamide regimen. When WTP is 3 times of GDP, the reveratrol regimen is more economical.