纳武利尤单抗治疗含铂方案化疗失败且PD-L1>1%的非小细胞肺癌的经济学评价  

Cost-effectiveness of nivolumab for recurrent NSCLC progressing during or after previous platinum failure,and tumor PD-L1 expression (>1%)

作　　者：郑冬妮[1] 周后凤[1] 郑寒蕊 ZHENG Dong-ni;ZHOU Hou-feng;ZHENG Han-rui(The Fifth People's Hospital of Chengdu,Chengdu 611130;West China Hospital of Sichuan University,Chengdu 610041)

机构地区：[1]成都市第五人民医院,成都611130 [2]四川大学华西医院,成都610041

出　　处：《中南药学》2021年第1期153-157,共5页Central South Pharmacy

基　　金：四川省卫生和计划生育委员会项目(No.17PJ572)。

摘　　要：目的从医疗保健的角度,对纳武利尤单抗治疗铂类化疗失败进展的鳞状或非鳞状非小细胞肺癌(NSCLS)展开药物经济学评价,为国内NSCLS初始治疗失败的化疗药物选择及医保目录提供相应的依据。方法本研究根据中国多中心、大规模的RCT研究,建立决策树和Markov模型,采用成本效果分析,对铂类治疗失败且PD-L1>1%的NSCLS患者使用纳武利尤单抗和多西他赛进行经济学评价,并对结果进行敏感性分析。结果以2019年国内生产总值的3倍作为意愿支付阈值(WTP=212 321元),在治疗铂类双联化疗后进展的鳞状、非鳞状NSCLS患者时,与多西他赛方案相比,纳武利尤单抗方案治疗费用更高(150 825元vs 33 546.88元),更有效(QALY:6.95年vs 5.47年)。纳武利尤单抗方案增量成本效果比为79 241.97/QALY,具有经济性。在敏感性分析中,疾病无进展状态的纳武利尤单抗方案的成本被认为是该模型中最敏感的因素。结论在国内的社会意愿支付背景下,与多西他赛组相比,采用纳武利尤单抗方案治疗铂类化疗失败进展且PD-L1>1%的NSCLS经济性更好。Objective To determine the cost-effectiveness of nivolumab that has recently been approved for sale in China in the treatment of chemotherapy-refractory advanced squamous or non-squamous non-small cell lung cancer (NSCLS),and to provide corresponding basis for the selection of chemotherapy drugs and the list of medical insurance for NSCLS after failing the initial treatment.Methods Based on China’s multi-center,large-scale randomized controlled trial study,this study established a decision tree and Markov model,and used cost-effectiveness analysis to evaluate the economics of patients who failed the platinum therapy with nivolumab and docetaxel.Sensitivity analysis was performed.Results Take 3 times the GDP in 2019 as the willingness to paythreshold (WTP = ￥212 321) in the treatment of patients with squamous and non-squamous NSCLS who progressed after platinum-based double chemotherapy,compared with the docetaxel,nivolumab was more expensive (￥150 825.21 vs ￥33 546.88) and effective (QALY:6.95 a vs 5.47 a).The incremental cost-effectiveness ratio of nivolumab was ￥79 241.97/QALY that is economical.In the sensitivity analysis,the cost of nivolumab regimen for disease-free progression was considered the most sensitive factor in the model.Conclusion In the context of domestic social willingness to pay,for NSCLS with failure and progression of platinum chemotherapy with PD-L1 >1%,navulriumab is more economical than docetaxel.

关 键 词：纳武利尤单抗 非小细胞肺癌 经济学评价 

分 类 号：R95[医药卫生—药学]