卡度尼利单抗联合化疗一线治疗复发性或转移性宫颈癌的成本效果分析

Cost-effectiveness analysis of cadonilimab in combination with chemotherapy for the first-line treatment of recurrent or metastatic cervical cancer

关键词:  卡度尼利单抗  宫颈癌  药物经济学  成本-效果分析

Key words:  cadonilimab  cervical cancer  pharmacoeconomics  cost-effectiveness analysis

摘要:

目的 从我国卫生体系角度出发，评论卡度尼利单抗联合标准化疗用于治疗复发性或转移性宫颈癌的经济性。方法 基于COMPASSION-16临床研究数据，建立Markov模型模拟宫颈癌疾病发展过程，模拟研究时限为10年，21d为一个周期。以质量调整生命年(QALYs)计算增量成本-效果比(ICER)值作为基础结果，并与意愿支付阈值(WTP)进行比较，采用敏感性分析验证模型的稳健性。结果 基础结果分析显示，卡度尼利单抗组成本为487111.92元，与安慰剂组相比成本增加了313761.9元，同时卡度尼利单抗组增加了0.5 QALYs，ICER值为628736.84元·QALY-1，高于WTP阈值287247元·QALY-1。敏感性分析中，卡度尼利单抗成本、效用值是对ICER值影响最大的因素。医保报销情景分析结果显示，当治疗方案报销70%时，卡度尼利单抗组ICER为188621.05元·QALY-1，推算出报销比例≥54.31%时，ICER≤218772.67元·QALY-1，卡度尼利单抗组具有经济性。结论 在卡度尼利单抗被纳入2024年国家医保目录后，当治疗方案医保报销比例≥54.31%时，其联合标准化疗在WTP阈值为3倍中国2024年人均GDP时具有经济性。

Abstract:

OBJECTIVE To evaluate the economics of cadonilimab in conjunction with standard chemistry for the treatment of recurrent or metastatic cervical cancer from the standpoint of our health system. METHODS Based on the COMPASSION-16 data from the clinical study, a Markov model was developed to simulate the disease progression of cervical cancer, and the time frame of the simulation study was 10 years, with 21 days as a cycle. Quality-adjusted life years (QALYs) were used to compute the incremental cost-effectiveness ratio (ICER) as the base result and the sensitivity analysis was used to confirm the model's robustness in comparison with the willingness-to-pay threshold (WTP). RESULTS The baseline results analysis demonstrated that the cost of the cadonilimab group was 487111.92 yuan, which was an increase in cost of 313761.9 yuan compared with the placebo group, as well as an increase of 0.5 QALYs in the cadonilimab group, and the ICER value was 628736.84 yuan QALY-1, above the the WTP threshold value of 287247 yuan QALY-1. The cost of cadonilimab and utility value were the most affecting elements on the ICER value in the sensitivity analysis. The results of the health insurance reimbursement scenario analysis showed that when the treatment plan was reimbursed at 70%, the ICER of the cadonilimab group was 188621.05 yuan QALY-1, which was extrapolated to be economical for the cadonilimab group when the reimbursement rate was ≥54.31% and the ICER was ≤218772.67 yuan QALY-1. CONCLUSION After cadonilimab was included in the 2024 National Health Insurance Catalog, its combination with standard chemotherapy was economical when the treatment regimen health insurance reimbursement ratio was ≥54.31% at a WTP threshold of 3 times China's 2024 per capita GDP.