Wan Xiao Min, Peng Liu Bao, Ma Jin An, Li Yuan Jian
Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
Department of Pharmacology, School of Pharmaceutical Sciences, Central South University, Changsha, Hunan 410078, China.
Cancer. 2017 Jul 15;123(14):2634-2641. doi: 10.1002/cncr.30666. Epub 2017 Mar 16.
Nivolumab is a new standard of care for patients with metastatic renal cell carcinoma (mRCC) and provides an overall survival benefit of 5.40 months in comparison with everolimus. This study evaluated the cost-effectiveness of nivolumab for the second-line treatment of mRCC from the perspective of US payers and identified the range of drug costs for which the addition of nivolumab to standard therapy could be considered cost-effective from a Chinese perspective.
A partitioned survival model was constructed to estimate lifetime costs, life-years, and quality-adjusted life-years (QALYs). Costs were estimated for the US and Chinese health care systems. One-way and probabilistic sensitivity analyses were performed.
Nivolumab provided an additional 0.29 QALYs at a cost of $151,676/QALY in the United States. The probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100,000/QALY, at the current cost of nivolumab, the chance of nivolumab being cost-effective was 3.10%. For China, when nivolumab cost less than $7.90 or $9.70/mg, there was a nearly 90% likelihood that the incremental cost-effectiveness ratio for nivolumab would be less than $22,785 or $48,838/QALY, respectively.
For the United States, nivolumab is unlikely to be a high-value treatment for mRCC at the current price, and a price reduction appears to be justified. In China, value-based prices for nivolumab are $7.90 and $9.70/mg for the country and Beijing City, respectively. This study could and should inform the multilateral drug-price negotiations in China that may be upcoming for nivolumab. Cancer 2017;123:2634-41. © 2017 American Cancer Society.
纳武单抗是转移性肾细胞癌（mRCC）患者新的治疗标准，与依维莫司相比，其总生存获益为5.40个月。本研究从美国医保支付方的角度评估了纳武单抗用于mRCC二线治疗的成本效益，并确定了从中国角度来看，在标准治疗中添加纳武单抗可被视为具有成本效益的药物成本范围。
构建了一个分段生存模型来估计终身成本、生命年和质量调整生命年（QALY）。对美国和中国医疗保健系统的成本进行了估计。进行了单向和概率敏感性分析。
在美国，纳武单抗以每QALY 151,676美元的成本提供了额外的0.29个QALY。概率敏感性分析表明，在支付意愿阈值为每QALY 100,000美元时，以纳武单抗目前的成本，其具有成本效益的概率为3.10%。对于中国，当纳武单抗的成本低于7.90美元/毫克或9.70美元/毫克时，纳武单抗的增量成本效益比分别低于22,785美元/QALY或48,838美元/QALY的可能性接近90%。
对于美国而言，以当前价格，纳武单抗不太可能成为mRCC的高价值治疗药物，降价似乎是合理的。在中国，纳武单抗基于价值的价格分别为全国7.90美元/毫克和北京市9.70美元/毫克。本研究能够且应该为中国即将进行的纳武单抗多边药品价格谈判提供参考。《癌症》2017年；123:2634 - 41。©2017美国癌症协会
