晚期食管鳞状细胞癌一线多种PD-1抑制剂免疫治疗策略的成本-效用分析  

Cost-effectiveness analysis of multiple first-line PD-1 inhibitors immunotherapy strategies for advanced esophageal squamous cell carcinoma

作　　者：尹瑞华 王庆华[2] 郑红娟 李成辉 徐锡枫 傅健飞 YIN Ruihua;WANG Qinghua;ZHENG Hongjuan;LI Chenghui;XU Xifeng;FU Jianfei(School of Medicine,Shaoxing University,Shaoxing 312000,Zhejiang,Chian;Department of Medical Oncology,Jinhua Municipal Central Hospital,Jinhua 321000,Zhejiang,China)

机构地区：[1]绍兴文理学院医学院,浙江绍兴312000 [2]金华市中心医院肿瘤内科,浙江金华321000

出　　处：《中国肿瘤生物治疗杂志》2023年第2期150-155,共6页Chinese Journal of Cancer Biotherapy

基　　金：金华市科技计划项目(No.2019-4-008,No.2021-4-015)。

摘　　要：目的:评估多种PD-1抑制剂联合化疗用于晚期、复发或转移性食管鳞状细胞癌(ESCC)患者一线治疗的成本效用。方法:基于4项晚期ESCC一线Ⅲ期临床试验(JUPITER-06、ESCORT-1st、ORIENT-15和KEYNOTE-590研究),应用TreeagePro 2011软件建立传统的马尔科夫(Markov)模型,包括无进展生存期(PFS)、疾病进展(PD)和死亡3种状态,以质量调整生命年(QALY)为主要效用指标衡量健康结果,以增量成本-效用比(ICER)为治疗策略经济学效益的评价指标,进一步通过敏感性分析验证结果可靠性。结果:特瑞普利单抗联合化疗组、卡瑞利珠单抗联合化疗组、信迪利单抗联合化疗组、帕博利珠单抗联合化疗组和安慰剂联合化疗组的总成本分别为66327.58、63473.64、62268.18、295515.26和32753.79元,效用值分别为0.648、0.605、0.673、0.585和0.536 QALY;其中,信迪利单抗联合化疗组的ICER值为217018.13元/QALY,低于中国患者意愿支付阈值的242928元/QALY,是一种相对可接受的治疗策略。敏感性分析显示,贴现率及信迪利单抗的成本对模型影响最大。结论:在中国目前的经济形势下,信迪利单抗联合化疗是ESCC患者可接受的一种一线PD-1抑制剂免疫治疗的策略。Objective:To determine the cost-effectiveness of adding PD-1 inhibitors to standard chemotherapy as the first-line treatment in patients with advanced,relapsed or metastatic esophageal squamous cell carcinoma(ESCC).Methods:Based on four firstline phaseⅢclinical trials of advanced ESCC:JUPITER-06,ESCORT-1st,ORIENT-15 and KEYNOTE-590 studies,Treeage Pro 2011was used to establish traditional Markov model.The Markov model included three states:progression-free survival(PFS),progressive disease(PD)and death.Health outcomes were measured in quality-adjusted life years(QALYs)and incremental cost effectiveness ratio(ICER)was used to evaluate the economic benefits of treatment strategies.The sensitivity analysis was employed to further validate the above listed results.Results:The total cost of toripalizumab-chemotherapy group,camrelizumab-chemotherapy group,sintilimabchemotherapy group,pembrolizumab-chemotherapy group and placebo-chemotherapy group were 66327.58,63473.64,62268.18,295515.26,and 32753.79 yuan,respectively.The utility values were 0.648,0.605,0.673,0.585,and 0.536 QALY,respectively.Among them,the ICER value of sintilimab-chemotherapy group was 217018.13 yuan/QALY,which was lower than the Chinese willingness-topay(WTP)threshold(242928 yuan/QALY),and it was a comparatively acceptable treatment strategy.Sensitivity analysis showed that the discount rate and the cost of sintilimab had the greatest influence on the model.Conclusion:Under the current economic situation in China,sintilimab combined with chemotherapy is an acceptable first-line PD-1 inhibitors immunotherapy strategy for the treatment of advanced ESCC.

关 键 词：成本-效用分析 食管鳞状细胞癌 PD-1抑制剂 一线治疗 

分 类 号：R956[医药卫生—药学] R730.51