帕博利珠单抗治疗晚期非小细胞肺癌药物经济学分析  

Analysis of pharmacoeconomic evaluation of pembrolizumab in the treatment of advanced non-small cell lung cancer

作　　者：万宁 梁蔚婷[3] 陈卓佳[3] 刘韬[3] 季波 张强 WAN Ning;LIANG Weiting;CHEN Zhuojia;LIU Tao;JI Bo;ZHANG Qiang(Department of Clinical Pharmacy;Procurement Management Division,General Hospital of Southern Theater Command,Chinese People's Liberation Army,Guangzhou,510010,Guangdong,China;Post-doctoral Research Station,Guangzhou Huabo Biopharmaceutical Research Institute,Guangzhou,510010,Guangdong,China;Department of Pharmacy,Sun Yat-sen University Cancer Center/State Key Laboratory of Oncology in South China/Collaborative Innovation Center for Cancer Medicine,Guangzhou,510060,Guangdong,China)

机构地区：[1]中国人民解放军南部战区总医院临床药学科,广东广州510010 [2]广州华博生物制药研究所博士后工作站,广东广州510010 [3]中山大学肿瘤防治中心药学部/华南肿瘤学国家重点实验室/肿瘤医学协同创新中心/广东省鼻咽癌诊治研究重点实验室,广东广州510060 [4]中国人民解放军南部战区总医院采购管理科,广东广州510010

出　　处：《肿瘤药学》2022年第6期796-805,共10页Anti-Tumor Pharmacy

基　　金：广东省自然科学基金面上项目【粤基金字〔2021〕4号】(2021A1515012251)。

摘　　要：目的对目前国内外已发表的帕博利珠单抗治疗晚期非小细胞肺癌的药物经济学评价进行分析,为后续其他免疫疗法药物经济学研究的开展提供参考与借鉴。方法通过PubMed、万方、中国知网等数据库进行文献检索,对纳入研究的方法、结果、局限性等进行分析。结果共纳入16篇帕博利珠单抗治疗晚期非小细胞肺癌的药物经济学评价文献进行总结分析。已发表的研究均基于大型Ⅲ期临床试验,通过Markov和分区生存模型及微观仿真模型等进行成本-效果分析,各研究选取的研究角度多为医保支付方或医疗保健系统,均以患者质量调整生命年(QALY)为效果指标。帕博利珠单抗单药或联合治疗可获得更多QALYs,但成本也更高,引入PD-L1检测可以在一定程度上提高经济性。结论帕博利珠单抗在美国更具经济性,与其抗肿瘤药物意愿支付阈值设定较高有一定的关系(相比于英国、法国和中国)。帕博利珠单抗在不同PD-L1表达水平患者中的经济性也表现出一定的差异。帕博利珠单抗的降价以及根据PD-L1检测结果来决定是否使用帕博利珠单抗,也可在一定程度上提高治疗方案的经济性。纳入研究质量水平较高,但在生存曲线的外推方面仍有一定局限性,未来可以多开展基于真实世界研究数据的药物经济学研究。Objective To analyze the domestic and foreign pharmacoeconomic evaluation of pembrolizumab in the treatment of advanced non-small cell lung cancer,and to provide references for pharmacoeconomic studies of other immune checkpoint inhibitors.Methods Literature retrieval was performed through PubMed,Embase and Wanfang database etc.,and the research methods,results and limitations of the included researches were analyzed.Results The current study included a total of 16 pharmacoeconomic evaluations of pembrolizumab in the treatment of advanced non-small cell lung cancer for review and analysis.The included studies all were based on phageⅢclinical trials.The cost-effectiveness analysis was conducted by Markov model,partition survival model or the microscopic simulation model.The studies all took a research data from medical insurance payers or health care system.Quality-adjusted life year(QALY)was used for the evaluation of effectiveness.The final results showed that more QALYs could be obtained with pembrolizumab monotherapy or combination therapy,but the cost was also higher,and the introduction of PD-L1 test could improve the cost-effective probabilities of pembrolizumab.Conclusion Pembrolizumab was more cost-effective in the United States,which had a certain relationship with its higher willingness to pay threshold for anti-tumor drugs,as compared to the United Kingdom,France and China.The pharmacoeconomic evaluation results of pembrolizumab in patients with different PD-L1 expression levels also showed certain differences.Using PD-L1 test for patient selection and price reduction could also improved the cost-effective probabilities of pembrolizumab.The quality of the included studies was relatively high,but there were still some limitations in extrapolating the survival curve.In the future,more pharmacoeconomic studies can be carried out on the base of real world research data.

关 键 词：帕博利珠单抗 非小细胞肺癌 药物经济学评价 MARKOV模型 分区生存模型 

分 类 号：R734.2[医药卫生—肿瘤] R730.51[医药卫生—临床医学] R956