度伐利尤单抗对比阿替利珠单抗一线治疗广泛期小细胞肺癌的成本-效果分析  

Cost-effectiveness analysis of durvalumab versus atezolizumab as a first-line treatment for extensivestage small cell lung cancer

作　　者：陈叶莉 龙云春 陈方 陈煜[1] CHEN Yeli;LONG Yunchun;CHEN Fang;CHEN Yu(Department of Pharmacy,First Affiliated Hospital,Xiamen University,Fujian Xiamen 361003,China;School of Basic Medical Sciences and Clinical Pharmacy,China Pharmaceutical University,Jiangsu Nanjing 211198,China)

机构地区：[1]厦门大学附属第一医院药学部,福建厦门361003 [2]中国药科大学基础医学与临床药学学院,江苏南京211198

出　　处：《中国医院药学杂志》2024年第7期815-821,共7页Chinese Journal of Hospital Pharmacy

基　　金：福建省自然科学基金项目(编号:2020D031);福建省卫健委中青年骨干项目(编号:2020GGB053)。

摘　　要：目的:该研究拟从国家医疗体系角度出发,评估度伐利尤单抗对比阿替利珠单抗一线治疗广泛期小细胞肺癌(extensive-stage small cell lung cancer,ES-SCLC)的成本-效果。方法:根据临床试验中的Kaplan-Meier曲线建立三状态马尔可夫模型模拟临床疗效和成本耗费。模型中仅计算直接医疗成本,效用值来自文献。以增量-成本效果比(incremental costeffectiveness ratio,ICER)作为结果指标。进行敏感性分析判断参数不确定性对模型稳定性的影响。结果:基础分析结果显示,与阿替利珠单抗组相比,度伐利尤单抗组的成本更高(292619元vs.436738元),但同时产出的质量调整生命年(quality adjusted life years,QALYs)(0.79 vs.0.88)也更多,ICER为1595446元/QALY。敏感性分析结果显示无进展生存期效用值、度伐利尤单抗和阿替利珠单抗价格以及贴现率对模型影响最大。结论:从国家医疗体系视角看,相比于阿替利珠单抗方案,度伐利尤单抗方案一线治疗ES-SCLC不具有成本-效果优势。OBJECTIVE Durvalumab/atezolizumab coupled with standard chemotherapy are currently only first-line immunotherapies as recommended by domestic and foreign guidelines for extensive-stage small cell lung cancer(ES-SCLC).However,the economics of these two immunotherapies have remained ill-defined.Thus this study was intended to evaluate the costeffectiveness of two immunotherapies for ES-SCLC from the perspective of Chinese healthcare system.METHODS Based upon Kaplan-Meier curves in clinical trials,a triple-state Markov model was constructed for simulating clinical output and cost consumption.Only direct medical expenses were calculated in the model and utility values obtained from the literature.Incremental costeffectiveness ratio(ICER)was utilized as an outcome index.Sensitivity analysis was performed for determining the impact of parametric uncertainty on model stability.RESULTS Basic analysis revealed that,as compared with atezolizumab group,expense of durvalumab group was higher(292619 vs.436738 yuan).However,more quality adjusted life years(QALYs)were obtained(0.79 vs.0.88)and ICER was 1595446 yuan/QALY.Sensitivity analysis indicated that utility value in progressionfree survival(PFS)stage,price of durvalumab/atezolizumab and discount rate had the greatest impact on the model.CONCLUSION From the perspective of Chinese healthcare system,durvalumab regimen is not cost-effective as a first-line treatment of ES-SCLC as compared with atezolizumab regimen.

关 键 词：度伐利尤单抗 阿替利珠单抗 小细胞肺癌 成本-效果分析 马尔可夫模型 

分 类 号：R956[医药卫生—药学]