阿得贝利单抗联合化疗一线治疗广泛期小细胞肺癌的成本效果分析

Cost-effectiveness Analysis of Adebrelimab Combined with Chemotherapy in First Line Treatment of Extensive Stage Small-cell Lung Cancer

关键词:  阿得贝利单抗  小细胞肺癌  成本效用分析  药学  经济学

Key words:  adebrelimab  small cell lung carcinoma  cost-utility analysis  pharmaceutical  economics

摘要:

目的 从中国医疗卫生体系角度评价阿得贝利单抗联合化疗对比化疗一线治疗广泛期小细胞肺癌的成本效果。方法 采用CAPSTONE-1临床试验所获数据(阿得贝利单抗组230例，化疗组232例)，建立马尔可夫模型模拟广泛期小细胞肺癌疾病过程。分别计算每组的总成本、质量调整生命年(quality-adjusted life-years，QALYs)、增量成本效果比(incremental cost-effectiveness ratio，ICER)。对关键参数进行敏感性分析。结果 与单纯化疗方案(依托泊苷联合卡铂)相比，在考虑慈善援助的情景下，阿得贝利单抗联合化疗的ICER为157128.79元·QALY^-1，在不考虑慈善援助的条件下，阿得贝利单抗联合化疗的ICER为351367.27元·QALY^-1。敏感性分析结果显示效用值和阿得贝利单抗的价格是主要的影响因素。结论 阿得贝利单抗联合化疗方案对比单纯化疗方案治疗广泛期小细胞肺癌在中国现有的经济水平下不具有成本效果优势；考虑慈善赠药时，阿得贝利单抗联合化疗方案具有成本效果优势的概率为44.5%。

Abstract:

OBJECTIVE To evaluate the cost-effectiveness of adebrelimab combined with chemotherapy versus chemotherapy alone in the first-line treatment of extensive stage small cell lung cancer from Chinese healthcare system perspective. METHODS Using the data obtained from the CAPSTONE-1 trial(230 cases for adebrelimab group, and 232 cases for chemotherapy group), Markov model was created for simulation of the disease development process of the extensive stage small cell lung cancer. The total costs, quality-adjusted life-years(QALYs) and incremental cost-effectiveness ratio(ICER) in each group were calculated. The sensitivity of key parameters was analyzed. RESULTS Compared with pure chemotherapy(etoposide plus carboplatin chemotherapy), the ICER of adebrelimab combined with chemotherapy was 157128.79 yuan·QALY^-1 under the situation of charity assistance, and 351367.27 yuan·QALY ^-1 in the environment of no charity assistance. Sensitivity analysis showed that the utility and the cost of adebrelimab were the main influence parameter. CONCLUSION Adebrelimab combined with chemotherapy regimen has no cost-effective advantage versus chemotherapy alone in the treatment of extensive stage small cell lung cancer under the current economic level of China; the probability of adebrelimab combined with chemotherapy being cost- effectiveness was 44.5% under the situation of charity assistan.