免疫检查点抑制剂联合化疗一线治疗晚期非小细胞肺癌的成本-效用分析

Cost-utility Analysis of PD-1/PD-L1 Inhibitor Combination Therapies as First-line Treatment for Advanced Non-small-cell Lung Cancer

关键词:  非小细胞肺癌  免疫检查点抑制剂  马尔科夫模型  成本-效用分析  药物经济学

Key words:  Non-small-cell lung cancer  Immune-checkpoint inhibitors  Markov model  Cost-utility analysis  Pharmacoeconomics

摘要:

摘要:目的 从中国医疗卫生体系的角度比较8种PD-1/PD-L1抑制剂联合治疗方案用于一线治疗晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）的成本-效用性，为临床及医保决策者提供参考。方法 相关数据来源于已发表的网络荟萃分析和随机对照试验，建立三状态的马尔科夫模型，对8种免疫联合治疗组合进行成本-效用分析，采用敏感性分析来验证结果的稳健性，并进行了一系列情景分析。结果 信迪利单抗联合化疗组和替雷利珠单抗联合化疗组的增量成本-效用比（incremental cost-utility ratio, ICUR）分别为125143.88元 /质量调整生命年（quality-adjusted life-year, QALY）和189609.64 元/QALY，小于意愿支付阈值（willingness-to-pay, WTP）257094 元/QALY，其余PD-1/PD-L1抑制剂联合治疗方案的ICUR均大于WTP，不具有经济性。情境分析发现，即使医保报销比例达到80%，帕博利珠单抗、阿替利珠单抗及纳武利尤单抗联合治疗方案均不具有经济性。结论 相比于其它PD-1/PD-L1抑制剂联合治疗方案，信迪利单抗联合化疗及替雷利珠单抗联合化疗一线治疗晚期NSCLC具有成本-效用优势，本研究结论可为NSCLC患者选用合理的治疗方案提供一定的参考依据。

Abstract:

ABSTRACT: OBJECTIVE To compare the cost-utility of eight PD-1/PD-L1 inhibitor combination regimens for first-line treatment of advanced non-small-cell lung cancer (NSCLC) from the perspective of Chinese healthcare system, and to provide reference for clinical and healthcare decision makers. METHODS Relevant data were derived from a published network meta-analysis and randomized controlled trails, a three-state Markov model was established to analyze the cost-utility of eight immunotherapy combinations. The robustness of results were validated through sensitivity analyses and a series of scenario analyses was also conducted. RESULTS The incremental cost-utility ratio (ICUR) of the sintilizumab plus chemotherapy group and the tislelizumab plus chemotherapy group were ￥125143.88 /quality adjusted life year（QALY） and ￥189609.64 /QALY, respectively, which were less than the willingness-to-pay (WTP) threshold of ￥257094 /QALY, and all the ICURs of other PD-1/PD-L1 inhibitor combination regimens exceeded the WTP threshold and were not economical. Scenario analyses found that even if the medical insurance reimbursement ratio reached 80%, the different combinations of pembrolizumab, nivolumab and atezolizumab were not economical. CONCLUSION Compared with other PD-1/PD-L1 inhibitor combination regimens, sintilizumab plus chemotherapy and tislelizumab plus chemotherapy have cost-utility advantages in the first-line treatment of advanced NSCLC, the conclusion of this study can provide a certain reference for selecting a reasonable treatment plan for NSCLC patients.