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引入等值生命年获益优化成本-效用分析——以RAS突变型转移性结直肠癌为例
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| 篇名： | 引入等值生命年获益优化成本-效用分析——以RAS突变型转移性结直肠癌为例 |
| TITLE： | Optimization of cost-utility analysis with equal value of life-year gained：a case study of RAS-mutant metastatic colorectal cancer |
| 摘要： | 目的 为我国药物经济学评估方法的完善和卫生经济决策提供参考。方法从我国医疗卫生体系的角度出发，基于BECOME研究构建三状态分区生存模型，分别以质量调整生命年（QALY）和等值生命年获益（evLYG）为健康产出指标，运用成本-效用分析法评价贝伐珠单抗联合化疗方案对比化疗方案一线治疗RAS突变型转移性结直肠癌（mCRC）的经济性。循环周期为2周，研究时限为患者终身，贴现率为5%，意愿支付阈值为1～3倍我国2023年人均国内生产总值（89358～268074元）。采用单因素敏感性分析和概率敏感性分析评价结果的稳健性。结果以QALY为基础计算的贝伐珠单抗联合化疗方案相较于化疗方案的增量成本-效果比（ICER）为330311.33元/QALY，大于意愿支付阈值（268074元）；以evLYG为基础计算的ICER值为254085.64元/evLYG，低于意愿支付阈值（268074元）。单因素敏感性分析结果显示，贝伐珠单抗成本对ICER值的影响最大。概率敏感性分析结果显示，以QALY为基础进行评估，贝伐珠单抗联合化疗方案更具经济性的概率约为3%；以evLYG为基础进行评估，该方案更加经济的概率上升至56%。结论采用按evLYG为健康产出指标计算的ICER值对RAS突变型mCRC患者医疗干预方案的经济性进行判断可能比按QALY计算的ICER值更为公平。建议针对特殊人群开展药物经济学评价时，可同时采用QALYs和evLYGs作为健康产出指标进行评估，以实现医疗卫生资源的更优配置，提高决策的公平性。 |
| ABSTRACT： | OBJECTIVE To provide a reference for the improvement of pharmacoeconomic evaluation and health economic decision-making in China. METHODS From the perspective of China’s healthcare system， a three-state partitioned survival model was constructed based on the BECOME study， the quality-adjusted life year （QALY） and equal value of life-year gained（evLYG） were used as the health gain measures respectively， and the cost-utility analysis was used to evaluate the cost-effectiveness of bevacizumab combined with chemotherapy regimen versus chemotherapy alone in the first-line treatment of RAS-mutant metastatic colorectal cancer （mCRC）. The cycle length was 2 weeks， the time horizon was the patients’ lifetime， the discount rate was 5%， and the willingness-to-pay threshold was 1 to 3 times China’s gross domestic product per capita in 2023 （89 358-268 074 yuan）. One-way sensitivity analysis and probabilistic sensitivity analysis were used to assess the robustness of the results. RESULTS Compared to the chemotherapy alone， the incremental cost-effectiveness ratio （ICER） of the bevacizumab combined with chemotherapy regimen was calculated to be 330 311.33 yuan/QALY based on QALY， which exceeded the willingness-to-pay threshold （268 074 yuan）. However， when the ICER was calculated based on evLYG， it was determined to be 254 085.64 yuan/evLYG， which fell below the willingness-to-pay threshold （268 074 yuan）. The results of the one-way sensitivity analysis showed that the price of bevacizumab had the greatest impact on the ICER value. The results of the probabilistic sensitivity analysis showed that the probability of the bevacizumab combined with chemotherapy regimen being more cost-effective was approximately 3% when assessed by QALY； the probability of the regimen being more cost-effective rose to 56% when assessed by evLYG. CONCLUSIONS When evaluating the cost-effectiveness of interventions for RAS-mutant mCRC， ICER values based on evLYG may provide a fairer measure compared to ICER values calculated by QALY. It is recommended that when pharmacoeconomic evaluations are conducted for special populations， both QALY and evLYG can be used as health outcome indexes for evaluation to achieve a better allocation of healthcare resources and improve the fairness of decision-making. |
| 期刊： | 2024年第35卷第18期 |
| 作者： | 胡钊；管欣；刘永军 |
| AUTHORS： | HU Zhao，GUAN Xin，LIU Yongjun |
| 关键字： | 等值生命年获益；质量调整生命年；RAS突变型转移性结直肠癌；药物经济学 |
| KEYWORDS： | equal value of life-year gained；quality-adjusted |
| 阅读数： | 19 次 |
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