帕博利珠单抗联合化疗治疗晚期恶性胸膜间皮瘤的成本-效用分析  

Cost-utility analysis of pembrolizumab combined with chemotherapy for advanced malignant pleural mesothelioma

作　　者：胡韵佳 邹可卿 侯艳红[1] HU Yunjia;ZOU Keqing;HOU Yanhong(School of International Pharmaceutical Business,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

出　　处：《药物流行病学杂志》2024年第10期1107-1114,共8页Chinese Journal of Pharmacoepidemiology

基　　金：国家社会科学基金一般项目(22BGL252)。

摘　　要：目的从我国卫生医疗系统视角出发,评估帕博利珠单抗联合化疗一线治疗晚期恶性胸膜间皮瘤的经济性,为临床用药和卫生决议提供经济学参考。方法以IND227试验为基础,构建分区生存模型,周期为21 d,模拟至99%的患者死亡。模型产出指标为质量调整生命年(QALY),采用成本-效用分析法评价帕博利珠单抗联合化疗相对于单纯化疗治疗晚期恶性胸膜间皮瘤的经济性,并通过单因素敏感性分析和概率敏感性分析证明基础分析结果的稳健性。结果基础分析结果显示,与单纯化疗方案相比,帕博利珠单抗联合化疗方案的增量成本-效用比(ICUR)为1447296.58元/QALY,大于以3倍我国2023年人均国内生产总值(GDP)(268074元/QALY)作为的意愿支付(WTP)阈值,不具有经济性。患者在接受慈善赠药的情况下,ICUR为102236.18元/QALY,低于WTP阈值。单因素敏感性分析结果显示,帕博利珠单抗成本、效用贴现率和单纯化疗组支持治疗费用对结果的影响更显著。概率敏感性分析结果显示,基础分析结果稳健性较好。结论在WTP阈值为3倍我国2023年人均GDP时,与单纯化疗方案相比,帕博利珠单抗联合化疗治疗晚期恶性胸膜间皮瘤不具有经济性。但若患者接受慈善赠药,则帕博利珠单抗联合化疗方案更具有经济性。Objective To explore and evaluate the economy of pembrolizumab combined chemotherapy in the first-line treatment of advanced malignant pleural mesothelioma from the perspective of China's healthcare system,and to provide pharmacoeconomic evidence and reference for clinical medication and related health decisions.Methods A partition survival model was constructed based on the IND227 study data,with 21 d as the model period and simulated to 99%of patients died.The model output index was the quality-adjusted life year(QALY).The cost-utility analysis was used to evaluate the economics of combination chemotherapy for advanced malignant pleural mesothelioma by chemotherapy alone.Further,the robustness of the basic analysis results was proved by univariate sensitivity analysis and probabilistic sensitivity analysis.Results The results of basic analysis showed that compared with chemotherapy alone,the incremental cost-utility ratio(ICUR)of pembrolizumab combined with chemotherapy was 1447296.58 yuan/QALY,which was greater than 3 times China's per capita GDP(268074 yuan/QALY)in 2023 as the willingness-to-pay(WTP)threshold,which was not economical.In the case of receiving charity drug donations,the ICUR was 102236.18 yuan/QALY,which was below the WTP threshold.The results of univariate sensitivity analysis showed that the cost of pembrolizumab,utility discount rate and supportive therapy in the chemotherapy group had more significant effects on the results.The results of the probability sensitivity analysis showed that the basic analysis results showed good robustness.Conclusion At a WTP threshold of 3 times China's per capita GDP in 2023,pembrolizumab combined with chemotherapy is not cost-effective for treating advanced malignant pleural mesothelioma.However,if the patient receives charity donations,combination of pembrolizumab and chemotherapy is more cost-utility.

关 键 词：帕博利珠单抗 化疗 晚期恶性胸膜间皮瘤 分区生存模型 成本-效用分析 药物经济学评价 

分 类 号：R734.3[医药卫生—肿瘤]