阿贝西利、哌柏西利和瑞波西利一线治疗激素受体阳性晚期乳腺癌的成本-效用分析  

Cost-utility analysis of abemaciclib,palbociclib and ribociclib as first-line treatment in hormone receptorpositive advanced breast cancer

作　　者：李梦媛 管欣[1,2] 嵇欣悦 王雨菲 田磊 LI Mengyuan;GUAN Xin;JI Xinyue;WANG Yufei;TIAN Lei(School of InternationalPharmaceutical Business,China Pharmaceutical University,Nanjing 211198,China;Center ofPharmacoeconomic Evaluation,China Pharmaceutical University,Nanjing 211198,China)

机构地区：[1]中国药科大学国际医药商学院,南京211198 [2]中国药科大学药物经济学评价研究中心,南京211198

出　　处：《中国药房》2024年第16期2002-2008,共7页China Pharmacy

基　　金：山东省医疗保障局购买服务项目(No.7422100030)。

摘　　要：目的从中国医疗卫生体系角度分析阿贝西利、哌柏西利和瑞波西利联用芳香化酶抑制剂(AI)一线治疗激素受体阳性(HR+)晚期乳腺癌的经济性。方法采用分区生存模型对HR+晚期乳腺癌患者20年的疾病进程进行模拟,模拟周期为4周,模型产出为总成本和质量调整生命年(QALY),以5%的贴现率对成本和效果进行贴现。通过系统检索相关临床试验进行网状Meta分析,获取阿贝西利、哌柏西利、瑞波西利联合AI的疗效参数,以MONALEESA-2试验安慰剂组的生存曲线为基础进行生存拟合和外推。计算3种治疗方案的增量成本-效果比(ICER)和增量净货币效益(INMB)以评估其经济性,意愿支付阈值为3倍我国2023年人均国内生产总值(GDP);采用单因素敏感性分析和概率敏感性分析检测各个参数对结果的影响以及增量分析结果的稳健性。结果经过20年的模拟,与哌柏西利+AI方案相比,瑞波西利+AI方案的ICER为58558.38元/QALY,INMB为62988.20元;与瑞波西利+AI方案相比,阿贝西利+AI方案的ICER为264928.34元/QALY,INMB为344.84元。单因素敏感性分析显示,阿贝西利+AI方案对比瑞波西利+AI方案的增量分析结果不稳健。概率敏感性分析证实,当阈值为1~3倍我国2023年人均GDP时,瑞波西利+AI方案成为最经济方案的概率最高。结论当阈值为1~3倍我国2023年人均GDP时,瑞波西利+AI方案一线治疗中国HR+晚期乳腺癌患者,较阿贝西利+AI方案和哌柏西利+AI方案更可能成为最经济的方案。OBJECTIVE To analyze the cost-effectiveness of abemaciclib,palbociclib and ribociclib combined with aromatase inhibitors(AI)in first-line treatment of hormone receptor-positive(HR+)advanced breast cancer from the perspective of Chinese medical system.METHODS The 20-year disease course of the patients was simulated by the partitioned survival model,and the simulation period was determined to be 4 weeks,the model output was the total cost and quality-adjusted life year(QALY),the cost and effect were discounted at a discount rate of 5%.A network meta-analysis was constructed by systematically searching relevant clinical trials to obtain the efficacy parameters of abemaciclib,palbociclib and ribociclib combined with AI.Survival fitting and extrapolation were performed based on the survival curve of the placebo group in MONALEESA-2 trial.Cost-effectiveness was assessed by incremental cost-effectiveness ratio(ICER)and incremental net monetary benefit(INMB),with a willingness-to-pay threshold of 3 times China’s per capita gross domestic product(GDP)in 2023;one-way sensitivity analysis and probability sensitivity analysis were used to detect the influence of parameters on the results and the robustness of the incremental analysis results.RESULTS In the 20-year simulation,compared with palbociclib+AI scheme,the ICER of ribociclib+AI scheme was 58558.38 yuan/QALY and the INMB was 62988.20 yuan.Compared with ribociclib+AI scheme,the ICER of abemaciclib+AI scheme was 264928.34 yuan/QALY and the INMB was 344.84 yuan.One-way sensitivity analysis showed that the incremental analysis results of abemaciclib+AI scheme compared to ribociclib+AI scheme were not robust.Probabilistic sensitivity analysis confirmed that the probability of ribociclib+AI scheme becoming the most economical was the highest when the threshold was 1-3 times China’s per capita GDP in 2023.CONCLUSIONS Ribociclib+AI scheme is more likely to be the most economical first-line treatment than abemaciclib+AI scheme and palbociclib+AI scheme in Chinese patients

关 键 词：晚期乳腺癌 激素受体阳性 阿贝西利 哌柏西利 瑞波西利 分区生存模型 成本-效用分析 增量净货币收益 

分 类 号：R956[医药卫生—药学]