恶性间皮瘤患者一线化疗后转换吉西他滨维持治疗的成本-效用分析  

Cost-utility analysis of switching to gemcitabine maintenance therapy for malignant mesothelioma patients after first-line chemotherapy

作　　者：游隽[1] 辛文秀 何超能 方琦璐 YOU Jun;XIN Wenxiu;HE Chaoneng;FANG Qilu(Dept.of Pharmacy,Zhejiang Cancer Hospital,Hangzhou 310022,China)

机构地区：[1]浙江省肿瘤医院药剂科,杭州310022

出　　处：《中国药房》2025年第7期843-847,共5页China Pharmacy

基　　金：浙江省医药卫生科技计划项目(No.2023KY608)。

摘　　要：目的从中国卫生体系的角度出发,评估不可切除的恶性间皮瘤患者经一线化疗后,转换吉西他滨维持治疗的经济性。方法根据NVALT19试验数据构建分区生存模型,循环周期为21 d,研究时限为10年,贴现率为5%。模型的主要输出参数包括总成本、质量调整生命年(QALY)、增量成本和增量成本-效果比(ICER)等。采用成本-效用分析法评价不可切除的恶性间皮瘤患者经一线化疗后转换吉西他滨维持治疗(吉西他滨组)方案相对于采用最佳支持治疗(支持治疗组)方案的经济性,并进行敏感性分析。结果与支持治疗组方案相比,吉西他滨组方案的ICER为54860.50元/QALY,远小于以3倍2023年我国人均国内生产总值作为的意愿支付阈值(268077元/QALY),说明吉西他滨组方案具有经济性。单因素敏感性分析结果显示,临终关怀成本和吉西他滨组不良事件处理成本对ICER的影响较大;概率敏感性分析结果表明,当意愿支付阈值大于270000元/QALY时,吉西他滨组方案具有经济性的概率为100%。结论从中国卫生体系的角度出发,不可切除的恶性间皮瘤在一线化疗后转换吉西他滨维持治疗的方案具有经济性。OBJECTIVE To evaluate the cost-utility of switching to gemcitabine maintenance therapy for patients with unresectable malignant mesothelioma after first-line chemotherapy from the perspective of China’s healthcare system.METHODS A partitioned survival model was constructed based on data from the NVALT19 trial,with a cycle length of 21 days,a time horizon of 10 years,and a discount rate of 5%.Key model outputs included total costs,quality-adjusted life year(QALY),incremental costs,and incremental cost-effectiveness ratio(ICER),etc.Cost-utility analysis was conducted to evaluate the cost-effectiveness of gemcitabine maintenance therapy(gemcitabine group)plan versus best supportive care(supportive care group)plan for the patients with unresectable malignant mesothelioma after first-line chemotherapy.Sensitivity analyses were performed.RESULTS Compared with the supportive care group plan,the gemcitabine group plan had an ICER of 54860.50 yuan/QALY,which was significantly lower than the willingness-to-pay(WTP)threshold(3 times China’s 2023 per capita gross domestic product,268077 yuan/QALY),indicating that gemcitabine group plan was cost-effective.One-way sensitivity analysis revealed that end-of-life care costs and adverse event management costs in the gemcitabine group had the greatest impact on ICER.Probabilistic sensitivity analysis showed gemcitabine group plan was 100%cost-effective when WTP exceeded 270000 yuan/QALY.CONCLUSIONS From the perspective of China’s healthcare system,switching to gemcitabine maintenance therapy after first-line chemotherapy is cost-effective for unresectable malignant mesothelioma.

关 键 词：恶性间皮瘤 维持治疗 吉西他滨 成本-效用分析 药物经济学 最佳支持治疗 

分 类 号：R956[医药卫生—药学] R734.3