阿帕替尼联合多柔比星二线治疗铂类耐药的复发性卵巢癌的成本-效果分析-中国药房

阿帕替尼联合多柔比星二线治疗铂类耐药的复发性卵巢癌的成本-效果分析

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篇名：	阿帕替尼联合多柔比星二线治疗铂类耐药的复发性卵巢癌的成本-效果分析
TITLE：	Cost-effectiveness analysis of apatinib combined with adriamycin for second-line treatment of platinum-resistant recurrent ovarian cancer
摘要：	目的从中国卫生体系角度评价阿帕替尼联合多柔比星二线治疗铂类药物耐药的复发性卵巢癌（OC）的经济性。方法基于APPROVE试验和相关文献数据构建三状态分区生存模型，模型模拟时限为10年，循环周期为4周，成本和效果的贴现率为5%。以成本和质量调整生命年（QALYs）作为模型产出指标并计算增量成本-效果比（ICER），评价阿帕替尼联合多柔比星对比多柔比星单独化疗二线治疗铂类药物耐药的复发性OC的经济性，并采用单因素敏感性分析、概率敏感性分析以及情境分析验证基础分析结果的稳健性。结果基础分析结果表明，与单独化疗相比，阿帕替尼联合多柔比星方案的ICER为124678.25元/QALY，低于本研究设定的意愿支付（WTP）阈值（3倍我国2022年人均国内生产总值257094元）。情境分析结果显示，随着模拟时限的延长，阿帕替尼联合多柔比星方案的ICER逐渐降低，降幅逐渐减小，均低于本研究设定的WTP阈值。单因素敏感性分析结果显示，对ICER影响程度最大的因素包括疾病进展状态效用值、体表面积、贴现率和最佳支持治疗成本等。概率敏感性分析结果表明，在本研究设定的WTP阈值下，阿帕替尼联合多柔比星方案具有经济性的概率超过99%。结论从中国卫生体系角度，以3倍我国2022年人均国内生产总值为WTP阈值，阿帕替尼联合多柔比星对比多柔比星单独化疗二线治疗铂类药物耐药的复发性OC更具经济性。
ABSTRACT：	OBJECTIVE To evaluate the cost-effectiveness of apatinib combined with adriamycin in the second-line chemotherapy of platinum-resistant recurrent ovarian cancer （OC） from the perspective of the health system in China. METHODS A three-state partitioned survival model was constructed based on the APPROVE clinical trial and related literature data， with a model simulation time frame of 10 years and a 4-week cycle， and both cost and utility values were discounted using a 5% discount rate. Cost and quality-adjusted life years （QALYs） were used as a model output indicator and the incremental cost-effectiveness ratio （ICER） was calculated to evaluate the cost-effectiveness of apatinib combined with adriamycin versus adriamycin chemotherapy in the second-line treatment of platinum-resistant recurrent OC. One-way sensitivity analysis， probability sensitivity analysis and scenario analysis were used to verify the robustness of the base-case analysis results. RESULTS The results of base-case analysis indicated that compared with chemotherapy alone， ICER of patients receiving apatinib combined with adriamycin was 124 678.25 yuan/QALY， which was less than willingness-to-pay （WTP） threshold set in this study [3 times per capita gross domestic product （GDP） of China in 2022 （257 094 yuan）]. The results of scenario analysis showed that， with the extension of the simulation time limit， the ICER of apatinib combined with adriamycin was gradually reduced， and the decline was gradually reduced， but both were less than WTP threshold. The results of single factor sensitivity analysis showed that the factors that had the greatest impact on ICER were the utility value of progression， body surface area， discount rate，and the cost of best supportive treatment， etc. The results of probability sensitivity analysis showed that under WTP threshold set in this study， the economic probability of apatinib combined with adriamycin was about 99%. CONCLUSIONS From the perspective of China’s health system， using three times the per capita GDP in 2022 as the WTP threshold， the combination of apatinib and adriamycin is more cost-effective than adriamycin alone in second-line chemotherapy for platinum-resistant recurrent OC.
期刊：	2024年第35卷第10期
作者：	詹少卿；柳小亚；周佳琦；陈霞
AUTHORS：	ZHAN Shaoqing，LIU Xiaoya，ZHOU Jiaqi，CHEN Xia
关键字：	阿帕替尼；多柔比星；铂类耐药；复发性卵巢癌；分区生存模型；成本-效果分析
KEYWORDS：	apatinib； adriamycin； platinum-resistant； recurrent ovarian cancer； partitioned survival model； cost-effectiveness
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