卡瑞利珠单抗联合化疗治疗中国晚期非小细胞肺癌的成本-效果分析  

Cost-effectiveness of Camrelizumab in Combination with Chemotherapy for Advanced Non-small-cell Lung Cancer in China

作　　者：顾永丽[1] 孙增先[1] 管欣[2] 李月 徐艺 GU Yongli;SUN Zengxian;GUAN Xin;LI Yue;XU Yi(Department of Pharmacy,the First People’s Hospital of Lianyungang,Lianyugang,222000,China;School of International Pharmaceutical Business,China Pharmaceutical University,Nanjing,211198,China)

机构地区：[1]连云港市第一人民医院药学部,连云港222000 [2]中国药科大学国际医药商学院,南京211198

出　　处：《药学与临床研究》2022年第5期475-479,共5页Pharmaceutical and Clinical Research

基　　金：江苏省药学会-恒瑞医院药学基金项目(H202116)。

摘　　要：目的:评价卡铂和培美曲塞联合卡瑞利珠单抗与单独化疗用于晚期非鳞状非小细胞肺癌(NSCLC)的成本-效果分析。方法:建立Markov模型,对卡瑞利珠单抗联合化疗与单独化疗一线治疗晚期非鳞状NSCLC进行成本-效果分析。临床效果参数和效用参数源于Ⅲ期临床试验(CameL试验)数据和国内外参考文献,结果指标包括成本、质量调整生命年(QALYs)和增量成本-效果比(ICER)。采用单因素和概率敏感性分析对结果进行分析,以评估模型结果的稳健性。结果:基础分析显示,卡瑞利珠单抗联合化疗可产生额外的0.395 QALY,增量成本为48786元,从卫生体系角度来看,对应于每个QALY的增量成本效益比为123509元。从医保支付方角度作情境分析,结果显示,从城镇居民医保角度卡瑞利珠单抗化疗的ICER为101959元,从职工医保角度ICER为103393元。结论:基于217341元/QALY的支付意愿阈值,对于中国晚期非鳞状NSCLC患者,卡瑞利珠单抗联合化疗的一线治疗相对于单独化疗具有经济学优势。Objective:Combining carboplatin and pemetrexed with camrelizumab has been associated with significantly longer progression-free survival of patients with advanced non-squamous non-small-cell lung cancer(NSCLC)than the chemotherapy without camrelizumab.Whether this survival benefit is costeffective,however,remains unclear.Methods:Based on the CameL trial,a Markov model was developed to compare costs,efficacy and as quality-adjusted life years(QALYs)between the chemotherapy alone and its combination with camrelizumab in the first-line treatment of advanced non-squamous NSCLC.The robustness of the results for the base case was assessed using deterministic and probabilistic sensitivity analyses.Results:In the base case,adding camrelizumab to the chemotherapy generated an additional0.395 QALY at an incremental cost of 48786 yuan,corresponding to an incremental cost-effectiveness ratio(ICER)of 123509 yuan per QALY from the perspective of Chinese healthcare systems.In secondary analysis from the Chinese payer’s perspective,ICER for camrelizumab with the chemotherapy was 101959yuan for urban residents with medical insurance and 103393 yuan for individuals with employee medical insurance.Conclusion:First-line treatment with camrelizumab plus chemotherapy is cost-effective with respect to chemotherapy alone for patients with advanced non-squamous NSCLC in China,based on a willingness-to-pay threshold of 123509 yuan per QALY.

关 键 词：成本-效果 非小细胞肺癌 卡瑞利珠单抗 化疗 

分 类 号：R956[医药卫生—药学]