纳武利尤单抗联合伊匹木单抗一线治疗不可切除恶性胸膜间皮瘤的经济性评价 点击下载
| 论文标题： | 纳武利尤单抗联合伊匹木单抗一线治疗不可切除恶性胸膜间皮瘤的经济性评价 |
| 英文标题： | |
| 中文摘要： | 目的 评价纳武利尤单抗联合伊匹木单抗一线治疗不可切除恶性胸膜间皮瘤（MPM）的经济性。方法从我国医疗保健系统角度出发，构建分区生存模型，采用成本-效用分析法比较纳武利尤单抗联合伊匹木单抗（双免疫治疗方案）对比化疗一线治疗不可切除MPM的经济性。临床数据来自CheckMate743研究，直接医疗成本包括药品费用、疾病管理费用和不良反应处理费用，成本和效用均按照5％的贴现率进行贴现。意愿支付阈值为3倍我国2021年人均国内生产总值（GDP）[242928元/质量调整生命年（QALY）]。通过情境分析比较双免疫治疗组患者接受赠药时这2种方案的经济性；通过单因素敏感性分析和概率敏感性分析评价研究结果的稳健性。结果基础分析结果表明，双免疫治疗方案的总成本高于化疗方案，同时效果也优于化疗方案，增量成本-效果比（ICER）为417122.2元/QALY，高于意愿支付阈值，双免疫治疗方案相比于化疗方案不具有经济性。患者在接受赠药的情况下，双免疫治疗方案的成本为327454.5元，ICER为75664.1元/QALY，低于意愿支付阈值，结果发生反转。单因素敏感性分析显示，无进展生存和疾病进展状态的效用值以及纳武利尤单抗价格等对ICER值影响较大；概率敏感性分析提示，基础分析结果稳健性较好。结论在3倍我国2021年人均GDP的支付意愿阈值下，相比于化疗方案，纳武利尤单抗联合伊匹木单抗一线治疗不可切除的MPM不具有经济性。但若患者接受赠药，则双免疫治疗方案更具有经济性。 |
| 英文摘要： | OBJECTIVE To evaluate the cost-effectiveness of nivolumab combined with ipilimumab in the first-line treatment of unresectable malignant pleural mesothelioma （MPM）. METHODS From the perspective of healthcare system ，a partitioned survival model were developed ，the cost-effectiveness of nivolumab combined with ipilimumab （dual-immunotherapy plan ）versus chemotherapy in the first-line treatment of unresectable MPM by cost-utility analysis. Clinical trial data were collected from CheckMate 743 study. Direct medical cost included drug costs ，disease management cost and cost of treatment of adverse reactions. Costs and utilities were discounted at an annual rate of 5％. The willingness to pay threshold was 3 times of gross domestic product （GDP）per capita in 2021 [242 928 yuan/QALY（quality-adjusted life year ）]. Scenario analysis was used to analyze and compare the two regimens under the scenario of complimentary drug for patients in dual-immunotherapy group. The robustness of the findings was evaluated by one-way sensitivity analysis and probabilistic sensitivity analysis. RESULTS Baseline analysis results showed that total cost of dual-immunotherapy regimen was higher than that of chemotherapy regimen ，and the utility was also better than that of chemotherapy plan ；the incremental cost-effectiveness ratio （ICER）was 417 122.2 yuan/QALY，which was higher than the willingness to pay threshold ；the dual-immunotherapy regimen was not cost-effective compared to the chemotherapy regimen. Under the scenario of complimentary drug ，the cost of dual-immunotherapy was 327 454.5 yuan，ICER was 75 664.1 yuan/QALY，which was lower than the willingness to pay threshold and resulted in a reversal of the baseline analysis. One-way sensitivity analysis showed that under the health states of progression free survival and progressive disease ，utility value and the price of nivolumab had a greater impact on the ICER value. Probabilistic sensitivity analysis showed that the results of baseline analysis were robust. CONCLUSIONS At a 163.com willingness to pay threshold of 3 times of GDP per capita in nivolumab combined with ipilimumab is not cost-effective compared with chemotherapy regimen in the first-line treatment of unresectable MPM. However ，if patients receive complimentary drugs ，the dual-immunotherapy regimen is cost-effective. |
| 期刊： | 2022年第33卷第16期 |
| 作者： | 杜怿，蒋蓉，申建，邵蓉 |
| 英文作者： | DU Yi，JIANG Rong，SHEN Jian，SHAO Rong |
| 关键字： | 纳武利尤单抗；伊匹木单抗；分区生存模型；恶性胸膜间皮瘤；成本-效用分析 |
| KEYWORDS： | nivolumab；ipilimumab；partitioned survival model ；malignant pleural mesoth elioma；cost-utility analysis |
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