阿替利珠单抗治疗化疗进展后晚期非小细胞肺癌的成本效用分析  

Cost-utility Analysis of Atezolizumab in the Second-Line Treatment of Metastatic Non-Small Cell Lung Cancer

作　　者：张川[1,2] 冉凤林 顾凌寒 刘悦 田攀文 李为民[4] ZHANG Chuan;RAN Fenglin;GU Linghan;LIU Yue;TIAN Panwen;LI Weimin(Department of Pharmacy and Evidence-Based Pharmacy Center,West China Second Hospital,Sichuan University,Chengdu 610041,China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Chengdu 610041,China;West China School of Pharmacy,Sichuan University,Chengdu 610041,China;Department of Pulmonary and Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院药学部/循证药学中心,成都610041 [2]四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]四川大学华西药学院,成都610041 [4]四川大学华西医院呼吸与危重症医学科,成都610041

出　　处：《医药导报》2022年第12期1854-1859,共6页Herald of Medicine

基　　金：国家自然科学基金重大研究计划集成项目(92159302)。

摘　　要：目的探索阿替利珠单抗与多西他赛二线治疗非小细胞肺癌(NSCLC)的成本效用,为阿替利珠单抗用于治疗NSCLC提供基于中国卫生视角的经济学评价依据。方法根据OAK临床试验,从中国卫生体系角度建立Markov模型。模型包括疾病未进展、疾病进展和死亡3个健康状态。模型的主要结果为总成本、质量调整生命年(QALY)和增量成本效用比(ICER),并进行单因素敏感性分析和概率敏感性分析探讨参数的不确定性。结果在晚期NSCLC的二线治疗中,阿替利珠单抗比多西他赛更昂贵但更有效,ICER每QALY率为406990.57元,与我国3倍人均国内生产总值(GDP)212676元比较,阿替利珠单抗不具有经济效益。阿替利珠单抗单价、三线用药纳武利尤单抗单价、进展后的效用值、贴现值和疾病无进展的效用值是影响结果的关键因素。在现有价格下,阿替利珠单抗较多西他赛具有成本-效用优势的概率低,当阿替利珠单抗价格降低到26674元时,可能具有成本-效用优势。结论以中国卫生体系为研究角度,阿替利珠单抗对比多西他赛治疗进展后的NSCLC在我国现有的经济水平下不具有成本-效用优势。Objective To explore the cost-effectiveness of atezolizumab compared with docetaxel in the second-line treatment of non-small cell lung cancer(NSCLC),to provide an economic evaluation basis for the use of atezolizumab in the treatment of NSCLC from the perspective of Chinese clinic.Methods Based on the OAK clinical trial,the Markov model was established from the perspective of Chinese healthcare.The model included three health states of progression-free survival,progress in disease and death.Outputs were total cost,quality-adjusted life-year(QALY),and incremental cost effectiveness ratio(ICER).Single factor sensitivity analysis and probability sensitivity analysis were carried out to explore the uncertainty of parameters.Results In the second-line treatment of advanced NSCLC,atezolizumab was more expensive but more effective than docetaxel.The ICER is 406990.57 yuan/QALY.Compared with the willingness-to-pay threshold(212676 yuan/QALY),atezolizumab was not cost-effective.The results of sensitivity analysis show that the price of atezolizumab,the price of third-line nivolumab,the utility value after progress,discount value,and the utility value without progress are the key factors affecting the results;When the price of atezolizumab is reduced to 26674 yuan,it may have cost-effectiveness.Conclusion From the perspective of Chinese healthcare,atezolizumab has no cost-effectiveness advantage compared with docetaxel in second-line treatment of advanced NSCLC.

关 键 词：阿替利珠单抗 非小细胞肺癌 药物经济学 成本效用分析 

分 类 号：R979.1[医药卫生—药品] R956[医药卫生—药学]