尼洛替尼与达沙替尼二线治疗慢性髓性白血病的成本效用分析  

Cost-Effectiveness Analysis of Nilotinib Versus Dasatinib as Second-Line Treatment of Chronic Myeloid Leukemia

作　　者：马玲 赵燕鸿 刘佳[1] 屠文莲[1] MA Ling;ZHAO Yanhong;LIU Jia;TU Wenlian(Dept.of Clinnical Pharmacy,The 1st People’s Hospital of Yunnan Province/The Affiliated Hospital of Kunming University of Science and Technology/Clinical pharmacy Center of Yunnan Province,Kunming Yunnan 650032;School of Pharmaceutical Sciences,Kunming Medical University,Kunming Yunnan 650500,China)

机构地区：[1]云南省第一人民医院/昆明理工大学附属医院/云南省临床药学中心临床药学,云南昆明650032 [2]昆明医科大学药学院,云南昆明650500

出　　处：《昆明医科大学学报》2024年第4期92-98,共7页Journal of Kunming Medical University

基　　金：云南省第一人民医院临床医学中心开放基金资助项目(2022LCZXKF-XY02);云南省临床药学中心建设单位开放课题基金资助项目(2023YJZX-YX02)。

摘　　要：目的评估费城染色体阳性慢性髓性白血病慢性期(Ph+CML-CP)患者中对伊马替尼耐药或不耐受的二线尼洛替尼与达沙替尼的成本效果。方法建立状态转移马尔可夫(Markov)模型进行成本效用分析,模型包括4种健康状态:慢性期(CP),加速期(AP),急变期(BP)和死亡。尼洛替尼与达沙替尼治疗的无进展生存率,疾病进展发生率,总生存率等有关临床参数来源于既往发表的研究和专家意见,健康状态效用值来源于文献。通过Treeage软件以增量成本效果比(ICER)作为评价指标,对尼洛替尼和达沙替尼2个方案的总产出和总成本进行评价,并通过单变量、概率敏感性分析评估模型稳定性。结果与选用达沙替尼治疗相比,选用尼洛替尼治疗的ICER为182487.71元·QALY^(-1),低于3倍2021年全国人均GDP。敏感性分析显示主要的影响参数有贴现率,达沙替尼价格和尼洛替尼价格,模型结果稳定。结论选用尼洛替尼相对达沙替尼用于对伊马替尼耐药或不耐受的Ph+CML-CP患者治疗具有成本效用优势。Objective To evaluate the cost-effectiveness of nilotinib versus dasatinib in the second-line treatment of Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase.Methods Establish a Markov model for cost-effectiveness analysis,including four health states:chronic phase(CP),accelerated phase(AP),blast phase(BP),and death.Clinical parameters related to progression-free survival rates,disease progression rates,overall survival rates,etc.for treatment with nilotinib and dasatinib are derived from previously published studies and expert opinions,while health state utility values are sourced from the literature.Using Treeage software,the incremental cost-effectiveness ratio(ICER)was used as an evaluation metric to assess the total output and total costs of the two schemes of nilotinib and dasatinib,and model stability is evaluated through univariate and probabilistic sensitivity analyses.Results Compared with using dasatinib for treatment,the ICER for using nilotinib treatment is 182487.71 yuan per QALY,which is less than 3 times the national per capita GDP in 2021.Sensitivity analysis showed that the main influencing parameters are the discount rate,dasatinib price,and nilotinib price,and the model results are stable.Conclusion Nilotinib has a cost-utility advantage over dasatinib in the treatment of Ph+CML-CP patients who are resistant or intolerent to imatinib.

关 键 词：尼洛替尼 达沙替尼 慢性髓性白血病 成本效果分析 二线治疗 

分 类 号：R973[医药卫生—药品]