阿替利珠单抗联合贝伐珠单抗与索拉非尼一线治疗不可切除肝细胞癌的药物经济学评价  

Economic Evaluation of Atezolizumab Plus Bevacizumab Versus Sorafenib in the First-line Treatment of Unresectable Hepatocellular Carcinoma

作　　者：刘瑞哲 邱凯锋[2] 江燕清 庞建新 Liu Ruizhe;Qiu Kaifeng;Jiang Yanqing;Pang Jianxin(Guangdong Provincial Key Laboratory of New Drug Screening,School of Pharmaceutical Sciences,Southern Medical University,Guangzhou 510515,China;Department of Pharmacy,Sun Yat-sen Memorial Hospital,Sun Yat-sen University)

机构地区：[1]南方医科大学药学院广东省新药筛选重点实验室,广州510515 [2]中山大学孙逸仙纪念医院药学部

出　　处：《中国药师》2022年第5期825-831,共7页China Pharmacist

基　　金：国家自然科学基金项目(编号:81974507)。

摘　　要：目的:从中国医疗保健系统角度和美国支付者角度出发,比较阿替利珠单抗联合贝伐珠单抗(AteBev)与拉非尼(Sor)在一线治疗不可切除肝细胞癌(uHCC)患者中的经济性。方法:基于Ⅲ期临床研究(IMbrave150)最新研究结果构建评价经济性的Markov模型和分区生存(PS)模型,循环周期为1个月,研究时限为10年。成本和效用来源于文献和数据库,转移概率和比例通过计算获得;模型主要结果包括总成本、总生命年(LYs)、总质量调整生命年(QALYs)和增量成本效果比(IC⁃ER)、增量净健康收益(INHB)、增量净货币收益(INMB)。通过将ICER值与意愿支付阈值(WTP)比较,判断两种方案的经济性。通过敏感性分析处理模型参数的不确定性。结果:基础分析中,从中国医疗保健系统角度出发,基于Markov模型和PS模型,AteBev方案相对于Sor方案的ICER值分别是138462美元/QALY、137056美元/QALY;从美国支付者角度出发,基于Markov模型和PS模型,AteBev方案相对于Sor方案的ICER值分别是492241美元/QALY、485804美元/QALY,ICER值均大于其意愿支付阈值(31499美元/QALY、150000美元/QALY),各种敏感性分析结果表明,基础分析结果稳定。结论:从中国医疗保健系统角度和美国支付者角度出发,在阈值为31499美元/QALY、150000美元/QALY时,Sor方案在一线治疗uHCC中更具经济性。Objective:To estimate the economic efficiency of atezolizumab plus bevacizumab(AteBev)versus sorafenib(Sor)in the first-line treatment of unresectable hepatocellular carcinoma from the perspective of Chinese healthcare system and that of U.S.payers.Methods:A Markov model and a partitioned survival model with 1 month cycle in 10 years horizon were adopted based on a phaseⅢclinical trial(IMbrave150).Costs and utility values were derived from literature and databases.The transition probabilities and proportions were estimated by calculation.Total costs,total life years(LYs),total quality adjusted life years(QALYs),incremental cost-effectiveness ratios(ICER),incremental net health benefits(INHB)and incremental net monetary benefits(INMB)were main outputs of the models.The economics of two strategies were judged by comparing the ICER values with the willingness-to-pay thresholds.To handle with the uncertainty of model parameters,sensitivity analyses were performed.Results:From the perspective of Chinese healthcare system,the base-case estimates of ICERs for AteBev versus Sor in the Markov model and partitioned survival model were 138462 dollars/QALY and 137056 dollars/QALY,respectively.From the perspective of U.S.payers,the base-case estimates of ICERs for AteBev versus Sor in the Markov model and partitioned survival model were 492241 dollars/QALY and 485804 dollars/QALY,respectively.All ICERs exceeded the willing-to-pay thresholds of 31499 dollars/QALY and 150000 dollars/QALY.All sensitivity analyses confirmed that the base-case results were stable.Conclusion:From the perspective of Chinese healthcare system and that of U.S.payers,Sor is more economical in the first-line treatment of unresectable hepatocellular carcinoma compared with AteBev at the adopted thresholds of 31499 dollars/QALY and 150000 dollars/QALY.

关 键 词：阿替利珠单抗 贝伐珠单抗 索拉非尼 肝细胞癌 成本⁃效果分析 

分 类 号：F407.7[经济管理—产业经济]