贝伐珠单抗联合标准化疗方案治疗复发性宫颈癌患者的成本-效果分析

Cost-effectiveness Analysis of Bevacizumab Combined with Standard Chemotherapy in Patients with Recurrent Cervical Cancer

关键词:  贝伐珠单抗  复发性宫颈癌  Markov模型  成本-效果分析

Key words:  bevacizumab  recurrent cervical cancer  Markov model  cost-effectiveness analysis

摘要:

目的 评价贝伐珠单抗（bevacizumab，BEV）联合标准化疗与仅标准化疗对复发性宫颈癌患者的成本效果性。方法 根据转移性宫颈癌患者疾病进展与转归过程，基于GOG-240试验，选择马尔可夫（Markov）模型对2种化疗方案进行经济学评价。该模型包括3个相互排斥的健康状态：PFS状态、PD状态和Death状态。效用值与成本单价参考当地某三甲医院费用标准或文献，并对结果进行敏感度分析。结果 模型运行10年结果显示，BEV的加入使得总成本增加233 974.10元（503 336.67元vs 269 362.57元）。相比标准化疗组，BEV的加入使总效用值增加0.17质量调整寿命年（quality-adjusted life year，QALY）（0.94 QALY vs 0.77 QALY），增量成本效果比为1 376 318.23元/QALY。一维敏感性分析结果显示，对该模型影响排名前3位的参数依次为BEV+标准化疗组的PFS、BEV的成本、PFS状态的效用值。概率敏感性分析结果显示，增量成本效益比值大于支付意愿（3倍GDP）的概率为100%。结论 相比标准化疗方案，BEV联合方案的增量成本效果比远远超过设定的意愿支付阈值，因此，考虑到BEV的单位成本以及其所带来的生存获益，BEV联合治疗不具有成本效果性。

Abstract:

OBJECTIVE To evaluate the cost-effectiveness of bevacizumab(BEV) combined with standard chemotherapy and standard chemotherapy only for patients with persistent or recurrent cervical cancer. METHODS According to the disease progression of patients with metastatic cervical cancer, the Markov model was chosen to evaluate the economics of the two chemotherapy regimens. The model included three mutually exclusive health states:PFS state, PD state, and Death state. The survival data came from the GOG-240 test. The utility value and cost unit price were derived from a local top three hospital in 2017 or references. Sensitivity analysis was performed on the results. RESULTS The model running for 10 years showed that the addition of BEV increased the total cost by 233 974.10 yuan (503 336.67 yuan vs 269 362.57 yuan). Compared with the standard chemotherapy group, the addition of BEV increased the total utility value by 0.17 quality-adjusted life year(QALY) (0.94 QALY vs 0.77 QALY) and the ICER was 1 376 318.23 yuan/QALY. The results of one-dimensional sensitivity analysis showed that the cost of PFS, BEV and PFS of BEV+chemotherapy group were the top three parameters influencing the model. The probability sensitivity analysis results showed that the probability of incremental cost-effectiveness ratio value greater than willingness to pay(3 times GDP) was 100%. CONCLUSION The incremental cost-effectiveness ratio of the BEV combination regimen far exceeds the established WTP compared to the standard chemotherapy regimen, so considering the unit cost of BEV and the survival benefits it brings, BEV combination therapy has no cost-effectiveness.