基于CARES 310和IMbrave 150的免疫联合疗法治疗不可切除肝细胞癌的经济性评价

Economic Evaluation of Immunotherapy Combinations for Unresectable Hepatocellular Carcinoma Based on CARES 310 and IMbrave 150 Trials

关键词:  免疫联合疗法  不可切除肝细胞癌  分数多项式模型  中国人群  经济性评价

Key words:  immunotherapy combination  unresectable hepatocellular carcinoma  fractional polynomial model  Chinese population  economic evaluation

摘要:

目的 对卡瑞利珠单抗联合阿帕替尼与阿替利珠单抗联合贝伐珠单抗用于一线治疗不可切除肝细胞癌的经济性展开评价。方法 采用IMbrave 150中国人群和CARES 310的试验数据,对比多种生存曲线的拟合模型,最终使用最优参数模型拟合生存曲线,使用分数多项式模型计算非恒定风险比进行间接比较；采用分区生存模型进行决策分析；进行单因素敏感性分析、概率敏感性分析,并绘制旋风图、成本效用散点图及成本效用可接受曲线。结果 卡瑞利珠单抗联合阿帕替尼组的总成本为117875元,总效用值为1.11 QALY；阿替利珠单抗联合贝伐珠单抗组总成本为633169元,总效用值为0.95 QALY,前者相对于后者的ICER为3136265元,INMB为562489,前者成本低于后者且前者总效用值高于后者。结果表明,在中国人群中卡瑞利珠单抗联合阿帕替尼均具有经济性优势。结论 与阿替利珠单抗联合贝伐珠单抗相比,在中国人群中卡瑞利珠单抗联合阿帕替尼作为一线治疗不可切除肝细胞癌的方案具有经济学上的优势。

Abstract:

OBJECTIVE To evaluate the economic performance of Camrelizumab combined with Rivoceranib versus Atezolizumab combined with Bevacizumab in the treatment of unresectable hepatocellular carcinoma. METHODS Data from the Chinese subgroup of IMbrave 150 and the whole of CARES 310 trials were used. Various survival curve fitting models were compared, and finally the Royston-Parmar model was used to fit the survival curves. The fractional polynomial model was used to calculate the non-constant hazard ratio for indirect comparison. A partitioned survival model was used for decision analysis. Sensitivity analyses were conducted, including deterministic and probabilistic sensitivity analyses, and tornado diagrams, cost-utility scatter plots, and cost-utility acceptability curves were generated. RESULTS The total cost for the Camrelizumab combined with Rivoceranib group was 117875 CNY, with a total utility value of 1.11 QALY; the Atezolizumab combined with Bevacizumab group had a total cost of 633169 CNY, with a total utility value of 0.95 QALY. The former's ICER relative to the latter was 3136265, and the INMB was 562489. The former has a lower cost than the latter and a higher total utility value. The results indicate that the combination of Camrelizumab and Rivoceranib has a cost-effectiveness advantage in the Chinese population. CONCLUSION Compared with the combination of Atezolizumab and Bevacizumab, the combination of Camrelizumab and Rivoceranib as first-line treatment for unresectable hepatocellular carcinoma demonstrates economic advantages in the Asian population.