Delea T E, Amdahl J, Nakhaipour H R, Manson S C, Wang A, Fedor N, Chit A
Policy Analysis Inc. ( pai ), Brookline, MA, U.S.A.
Health Outcomes-Oncology, Medical Division, GlaxoSmithKline, Mississauga, ON.
Curr Oncol. 2014 Dec;21(6):e748-59. doi: 10.3747/co.21.1899.
In the phase iii palette trial of pazopanib compared with placebo in patients with advanced or metastatic soft-tissue sarcoma (sts) who had received prior chemotherapy, pazopanib treatment was associated with improved progression-free survival (pfs). We used an economic model and data from palette and other sources to evaluate the cost-effectiveness of pazopanib in patients with advanced sts who had already received chemotherapy.
We developed a multistate model to estimate expected pfs, overall survival (os), lifetime sts treatment costs, and quality-adjusted life-years (qalys) for patients receiving pazopanib or placebo as second-line therapy for advanced sts. Cost-effectiveness was calculated alternatively from the health care system and societal perspectives for the province of Quebec. Estimated pfs, os, incidence of adverse events, and utilities values for pazopanib and placebo were derived from the palette trial. Costs were obtained from published sources.
Compared with placebo, pazopanib is estimated to increase qalys by 0.128. The incremental cost of pazopanib compared with placebo is CA$20,840 from the health care system perspective and CA$15,821 from the societal perspective. The cost per qaly gained with pazopanib in that comparison is CA$163,336 from the health care system perspective and CA$124,001 from the societal perspective.
Compared with placebo, pazopanib might be cost-effective from the Canadian health care system and societal perspectives depending on the threshold value used by reimbursement authorities to assess novel cancer therapies. Given the unmet need for effective treatments for advanced sts, pazopanib might nevertheless be an appropriate alternative to currently used treatments.
在一项III期帕唑帕尼与安慰剂对比的试验中，对于接受过一线化疗的晚期或转移性软组织肉瘤（STS）患者，帕唑帕尼治疗与无进展生存期（PFS）改善相关。我们使用经济模型以及来自PALETTE试验和其他来源的数据，评估帕唑帕尼在已接受化疗的晚期STS患者中的成本效益。
我们建立了一个多状态模型，以估计接受帕唑帕尼或安慰剂作为晚期STS二线治疗的患者的预期PFS、总生存期（OS）、终身STS治疗成本和质量调整生命年（QALYs）。从魁北克省的医疗保健系统和社会角度分别计算成本效益。帕唑帕尼和安慰剂的估计PFS、OS、不良事件发生率和效用值来自PALETTE试验。成本从已发表的来源获取。
与安慰剂相比，估计帕唑帕尼可使QALYs增加0.128。从医疗保健系统角度看，帕唑帕尼与安慰剂相比的增量成本为20,840加元，从社会角度看为15,821加元。在该比较中，帕唑帕尼每获得一个QALY的成本从医疗保健系统角度看为163,336加元，从社会角度看为124,001加元。
与安慰剂相比，根据报销当局评估新型癌症疗法所使用的阈值，从加拿大医疗保健系统和社会角度看，帕唑帕尼可能具有成本效益。鉴于晚期STS对有效治疗的需求未得到满足，帕唑帕尼仍可能是当前所用治疗方法的合适替代方案。
