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信迪利单抗联合化疗一线治疗晚期或复发性非小细胞肺癌的成本-效用分析
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| 篇名： | 信迪利单抗联合化疗一线治疗晚期或复发性非小细胞肺癌的成本-效用分析 |
| TITLE： | Cost-utility analysis of sintilimab combined with chemotherapy in first-line treatment of advanced or recurrent non-small cell lung cancer |
| 摘要： | 目的 从我国卫生体系角度出发，评价信迪利单抗联合化疗一线治疗晚期或复发性非小细胞肺癌（NSCLC）的经济性，为临床用药方案的选择及医疗卫生决策提供依据。方法基于ORIENT-11研究数据建立分区生存模型，以21d作为模型周期，模拟至99％的患者死亡。以质量调整生命年（QALY）作为产出指标，评价信迪利单抗联合化疗（试验组）对比单纯化疗（对照组）一线治疗晚期或复发性NSCLC的经济性。对成本和效用采用5％的贴现率进行贴现；采用敏感性分析和情境分析验证基础分析结果的稳健性。结果在以3倍2020年我国人均国内生产总值（GDP）作为意愿支付（WTP）阈值的前提下，试验组患者在获得更多效用（0.482QALY）的同时也需要花费近2倍于对照组的成本，增量成本-效果比（ICER）为334974.41元/QALY。单因素敏感性分析结果显示无进展生存状态效用值、培美曲塞价格、效用贴现率、成本贴现率和信迪利单抗价格对ICER的影响较大。概率敏感性分析结果表明，当WTP阈值为3倍2020年我国人均GDP时，试验组方案具有经济性的概率为6.5％。情境分析结果验证了基础分析结果的稳健性。结论在以3倍2020年我国人均GDP作为WTP阈值的前提下，信迪利单抗联合化疗对比单纯化疗一线治疗晚期或复发性NSCLC不具有经济性。 |
| ABSTRACT： | OBJECTIVE From the perspective o f China ’s h ealth service system ，to ev aluate the cost-effectiveness of sintilimab combined with chemotherapy in the first-line treatment of advanced or recurrent non-small cell lung cancer （NSCLC），so as to provide reference for the selection of clinical medication plan and medical and health decision-making. METHODS Based on the ORIENT-11 study data ，a partitioned survival model was established ，and the model period was 21 days to simulate the death of 99％ of the patients. Using quality-adjusted life years （QALY）as an output indicator ，the cost-effectiveness of sintilimab combined with chemotherapy （trial group ）versus chemotherapy alone （control group ）in the first-line treatment of advanced or recurrent NSCLC was evaluated. Cost and utility were discounted using 5％ discount rate ；sensitivity analysis and scenario analysis were used to verify the robustness of the underlying analysis results. RESULTS Under the premise that 3 times of the per capita gross domestic product （GDP）of China in 2020 was used as the threshold of willingness-to-pay （WTP），the patients in the trial group obtained more utility （0.482 QALY）and also spent nearly twice as much as the control group. The incremental cost-effectiveness ratio（ICER）was 334 974.41 yuan/QALY. Univariate sensitivity analysis showed that progression-free survival status utility value ， pemetrexed price ，utility discount rate ，cost discount rate and sintilimab price had a greater impact on ICER. The results of probability sensitivity analysis showed that when the WTP threshold was 3 times of China ’s per capita GDP in 2020，the probability of the trial group ’s plan being cost-effective was 6.5％. The results of the scenario analysis verified the robustness of the underlying analysis results. CONCLUSIONS On the premise of taking 3 times of China ’s per capita GDP in 2020 as the WTP threshold ， sintilimab combined with chemotherapy is not cost-effective for first-line treatment of advanced or recurrent NSCLC compared with chemotherapy alone. |
| 期刊： | 2022年第33卷第15期 |
| 作者： | 高红婷，胡梦雪，贾琳琳，吴方，侯艳红 |
| AUTHORS： | GAO Hongting ，HU Mengxue ，JIA Linlin，WU Fang，HOU Yanhong |
| 关键字： | 信迪利单抗；化疗；分区生存模型；非小细胞肺癌；成本-效用分析 |
| KEYWORDS： | sintilimab；chemotherapy；partitioned survival |
| 阅读数： | 228 次 |
| 本月下载数： | 6 次 |
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