多纳非尼治疗晚期肝细胞癌的药物经济学评价  

Cost-Effectiveness of Donafenib for Treating Patients with Advanced Hepatocellular Carcinoma

作　　者：郑水莲[1,2] 郑小卫 杨秀丽 胡颖[1,2] 官海静 ZHENG Shuilian;ZHENG Xiaowei;YANG Xiuli;HU Ying;GUAN Haijing(Center for Clinical Pharmacy,Department of Pharmacy,Zhejiang Provincial People's Hospital,Hangzhou 310014,China;Hangzhou Medical College,Hangzhou 311300,China;Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]浙江省人民医院,临床药学研究中心,药学部,杭州310014 [2]杭州医学院,杭州311300 [3]首都医科大学附属北京天坛医院,北京100070

出　　处：《中国药学杂志》2023年第17期1622-1628,共7页Chinese Pharmaceutical Journal

基　　金：国家自然科学基金项目资助(82003189)。

摘　　要：目的评估多纳非尼、阿替利珠单抗联合贝伐珠单抗、信迪利单抗联合贝伐珠单抗生物类似物治疗不可切除的晚期肝细胞癌患者的成本效果。方法基于卫生体系角度,采用分区生存模型,临床效果采用网状Meta分析,健康效用值来源于相关文献。结果多纳非尼组、阿替利珠单抗联合贝伐珠单抗组、信迪利单抗联合贝伐珠单抗生物类似物组的质量调整生命年(QALYs)分别为1.106、1.420、1.675 QALYs,直接医疗费用分别为291150、519432、436725元。阿替利珠单抗联合贝伐珠单抗组、信迪利单抗联合贝伐珠单抗生物类似物组相比于多纳非尼的增量成本效果比(incremental cost-effectiveness ratio,ICER)分别为727951、256035元/QALY,均高于中国3倍的人均国内生产总值(GDP)(242928元)。结论相比于两种联合治疗方案,多纳非尼一线治疗晚期肝细胞癌患者具有经济性。OBJECTIVE To evaluate the cost-effectiveness of donafenib,atezolizumab combined with bevacizumab,and sintilimab combined with bevacizumab biosimilars as first-line treatments for patients with unresectable advanced hepatocellular carcinoma(HCC).METHODS A partitioned survival model was developed to estimate the long-term clinical and economic outcomes from the perspective of healthcare systems.The clinical data of the three regimens were evaluated by a network Meta-analysis.Costs and health state utilities were derived from the latest published relevant literature.RESULTS Quality-adjusted life years(QALYs)gained by donafenib,atezolizumab combined with bevacizumab,and sintilimab combined with bevacizumab biosimilar were 1.106 QALYs,1.420 QALYs,and 1.675 QALYs,respectively,and the direct medical costs were 291150 RMB,519432 RMB,and 436725 RMB,respectively.Compared with donafenib,the incremental cost-effectiveness ratio(ICER)of atezolizumab combined with bevacizumab and sintilimab combined with bevacizumab biosimilar was 727951 RMB/QALY and 256035 RMB/QALY,which were higher than 3 times per capita gross domestic product(GDP)of China.CONCLUSION Compared with atezolizumab combined with bevacizumab and sintilimab combined with bevacizumab biosimilars,donafenib is more likely to be a cost-effective strategy in the first-line treatments of advanced HCC patients.

关 键 词：多纳非尼 阿替利珠单抗 信迪利单抗 贝伐珠单抗 贝伐珠单抗生物类似物 晚期肝细胞癌 成本效益分析 

分 类 号：R95[医药卫生—药学]