雷莫芦单抗单药二线治疗晚期胃或胃食管交界腺癌的药物经济学评价  

Pharmacoeconomic evaluation of ramucirumab as a single agent second-line chemotherapy for advanced gastric or gastro-oesophageal junction adenocarcinoma

作　　者：罗霞[1,4] 刘俏[1,4] 易利丹[1,4] 彭六保[1,4] 谭重庆[1,4] 李健和[1,4] 李斯妮 马芳[2] 曾小慧[3] LUO Xia;LIU Qiao;YI Li-dan;PENG Liu-bao;TAN Chong-qing;LI Jian-he;LI Si-ni;MA Fang;ZENG Xiao-hui(Department of Pharmacy,the Second Xiangya Hospital of Central South University,Changsha HU-NAN 410011,China;Department of Oncology,the Second Xiangya Hospital of Central South University,Changsha HU-NAN 410011,China;Department of Nuclear Medicine/PET Image Center,the Second Xiangya Hospital of Central South University,Changsha HU-NAN 410011,China;Institute of Clinical Pharmacy,Central South University,Changsha HU-NAN 410011,China)

机构地区：[1]中南大学湘雅二医院药学部,湖南长沙410011 [2]中南大学湘雅二医院肿瘤科,湖南长沙410011 [3]中南大学湘雅二医院核医学科/PET影像中心,湖南长沙410011 [4]中南大学临床药学研究所,湖南长沙410011

出　　处：《中国新药与临床杂志》2021年第8期582-587,共6页Chinese Journal of New Drugs and Clinical Remedies

基　　金：国家自然科学基金(81401547,81603081)。

摘　　要：目的从中国医疗卫生角度,对雷莫芦单抗(Ram)单药二线治疗晚期胃或胃食管交界腺癌进行药物经济学评价,并基于价值给出定价建议。方法构建Markov模型,评价Ram或安慰剂单药治疗策略下Ram不同定价时的总成本与总健康产出。根据REGARD实验数据,以增量成本效果比(ICER)为评价指标,从文献资料获得效用值和成本资料,并通过敏感性分析验证模型的稳健性。结果当Ram的价格为每2周1 282元时,Ram组的总成本为191 619元,安慰剂组的总成本为146 427元,ICER为347 631元·QALY^(-1),接近北京市的意愿支付成本(WTP)阈值(354 594元·QALY^(-1))。但即使Ram价格为0, ICER为269 923元·QALY^(-1),仍超过全国WTP阈值。敏感性分析结果显示, WTP为354 594元·QALY^(-1),Ram的价格低于每2周1 282元时,Ram组具有成本效果优势的可能性接近50%。结论基于价值的定价建议,在北京市Ram需低于每2周1 282元才可能具有成本效果优势。按我国目前的标准,Ram不具有成本效果优势。AIM From the perspective of China’s medical and health care, to evaluate the cost-effectiveness of ramucirumab(Ram) as a single agent second-line chemotherapy for advanced gastric or gastro-oesophageal junction adenocarcinoma and establish a value-based cost. METHODS A Markov model was established to evaluate the total cost and total health output with different pricing of Ram under treatment strategies with Ram or placebo only. Based on the REGARD data, the incremental cost-effectiveness ratio(ICER) was used as evaluation indicator. The utility value and disease-related cost were collected from other published studies. Sensitivity analysis was performed to verify the uncertainty. RESULTS When the price of Ram was 1 282 yuan per 2 weeks, the total cost of Ram group was 191 619 yuan, the total cost of placebo group was 146 427 yuan, and the ICER was 347 631 yuan·QALY^(-1), which was close to the willing to pay(WTP) threshold of Beijing city(354 594 yuan·QALY^(-1)). But even if the price of Ram was 0, the ICER was 269 923 yuan·QALY^(-1) which still exceeded the WTP threshold of China. The result of sensitivity analysis showed that when WTP was 354 594 yuan· QALY^(-1) and Ram was less than 1 282 yuan per 2 weeks, the probability of Ram group had a cost-effective advantage was close to 50%. CONCLUSION Based on the value-based pricing recommendation, Ram should be less than 1 282 yuan per 2 weeks to have a cost-effective advantage in Beijing. According to the current standards, Ram is impossible to be costeffective.

关 键 词：雷莫芦单抗 胃肿瘤 经济学 药学 成本效用分析 二线化疗 

分 类 号：K735.2[历史地理—历史学] R956[历史地理—世界史]