贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状NSCLC的成本-效用分析  

Cost-utility analysis of bevacizumab combined with erlotinib in the first-line treatment of advanced EGFR mutant non-squamous NSCLC

作　　者：居文祥 赵荧荧 路萝兰 张小涵 沈爱宗 JU Wenxiang;ZHAO Yingying;LU Luolan;ZHANG Xiaohan;SHEN Aizong(College of Pharmacy,Anhui University of Chinese Medicine,Hefei 230012,China;Anhui Province Medicines Clinical Comprehensive Evaluation Technology Center,Hefei 230001,China;Anhui Provincial Key Laboratory of Precision Pharmaceutical Preparation and Clinical Pharmacy,Hefei 230001,China;Anhui Provincial Key Laboratory of Philosophy and Social Sciences for Public Health and Social Governance,Hefei 230032,China;Discipline Key Laboratory for Key Technology Research and Clinical Application of Mass Spectrometry Jointly Constructed by Anhui Province,Hefei 230088,China;Dept.of Pharmacy,the First Affiliated Hospital of China University of Science and Technology,Hefei 230001,China)

机构地区：[1]安徽中医药大学药学院,合肥230012 [2]安徽省药品临床综合评价技术中心,合肥230001 [3]精准药物制剂与临床药学安徽省重点实验室,合肥230001 [4]公共健康社会治理安徽省哲学社会科学重点实验室,合肥230032 [5]质谱关键技术研发与临床应用安徽省联合共建学科重点实验室,合肥230088 [6]中国科学技术大学附属第一医院药学部,合肥230001

出　　处：《中国药房》2024年第11期1357-1362,共6页China Pharmacy

基　　金：安徽省高校协同创新项目(No.GXXT-2020-062)。

摘　　要：目的 从我国卫生体系角度出发,评价贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状非小细胞肺癌(NSCLC)的经济性。方法 基于BEVERLY研究数据构建动态Markov模型,循环周期为3周,模拟至模型中99%的患者死亡,年贴现率为5%。模型产出为总成本与质量调整生命年(QALY)以及增量成本-效果比(ICER)。以3倍我国2023年人均国内生产总值(GDP)作为意愿支付(WTP)阈值,采用成本-效用分析法评价贝伐珠单抗联合厄洛替尼相对于厄洛替尼单药一线治疗晚期EGFR突变型非鳞状NSCLC的经济性,并采用单因素敏感性分析和概率敏感性分析验证基础分析结果的稳健性。结果 基础分析结果显示,与厄洛替尼单药方案相比,贝伐珠单抗联合厄洛替尼方案的ICER为1 452 243.01元/QALY,大于以3倍我国2023年人均GDP(268 074元/QALY)作为的WTP阈值,不具有经济性。单因素敏感性分析结果显示,贝伐珠单抗成本、无进展生存期和疾病进展期状态的效用值对结果的影响较大。概率敏感性分析结果显示,当WTP阈值为1 740 000元/QALY时,贝伐珠单抗联合厄洛替尼方案具有经济性的概率为50%。结论 在以3倍我国2023年人均GDP作为WTP阈值时,与厄洛替尼单药方案相比,贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状NSCLC不具有经济性。OBJECTIVE To evaluate the cost-effectiveness of bevacizumab combined with erlotinib in the first-line advanced EGFR mutant non-squamous non-small cell lung cancer(NSCLC)from the perspective of China’s health METHODS A dynamic Markov model was established based on BEVERLY study data,with a cycle of 3 weeks,a research deadline until 99%of patients die,and an annual discount rate of 5%.The model outputs were total cost,quality-adjusted life year(QALY),and incremental cost-effectiveness ratio(ICER).Taking 3 times China’s per capita gross domestic product(GDP)in 2023 as the willingness-to-pay(WTP)threshold,the cost-utility analysis was used to evaluate the cost-effectiveness of bevacizumab combined with erlotinib(observation group)versus erlotinib alone(control group)in the first-line treatment of advanced EGFR mutant non-squamous NSCLC,and the single factor sensitivity analysis and probability sensitivity analysis were used to verify the robustness of the basic analysis results.RESULTS The results of the basic analysis showed that compared with the erlotinib therapy plan,ICER of bevacizumab combined with erlotinib was 1452243.01 yuan/QALY,which was more than 3 times China’s per capita GDP in 2023(268074 yuan/QALY)as the WTP threshold,indicating that bevacizumab combined with erlotinib was not cost-effective.The results of single factor sensitivity analysis showed that the cost of bevacizumab,the utility value of progression-free survival and progressed disease status had a great influence on the results.The results of probability sensitivity analysis showed that when the WTP threshold was 1740000 yuan/QALY,the probability of cost-effective of bevacizumab combined with erlotinib plan was 50%.CONCLUSIONS Compared with erlotinib alone,bevacizumab combined with erlotinib is not cost-effective in the first-line treatment of advanced EGFR mutant non-squamous NSCLC,when using 3 times China’s per capita GDP in 2023 as the WTP threshold.

关 键 词：贝伐珠单抗 厄洛替尼 动态Markov模型 成本-效用分析 表皮生长因子受体 非鳞状非小细胞肺癌 药物经济学评价 

分 类 号：R956[医药卫生—药学] R979.1