帕唑帕尼与舒尼替尼治疗英国转移性肾细胞癌的成本效益
Cost-effectiveness of pazopanib versus sunitinib for metastatic renal cell carcinoma in the United Kingdom.
作者信息
Amdahl Jordan, Diaz Jose, Sharma Arati, Park Jinhee, Chandiwana David, Delea Thomas E
机构信息
Research, Policy Analysis Inc. (PAI), Brookline, Massachusetts, United States of America.
Global Health Outcomes - Oncology, GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex, United Kingdom.
出版信息
PLoS One. 2017 Jun 21;12(6):e0175920. doi: 10.1371/journal.pone.0175920. eCollection 2017.
BACKGROUND
Sunitinib and pazopanib are the only two targeted therapies for the first-line treatment of locally advanced or metastatic renal cell carcinoma (mRCC) recommended by the United Kingdom's National Institute for Health and Care Excellence. Pazopanib demonstrated non-inferior efficacy and a differentiated safety profile versus sunitinib in the phase III COMPARZ trial. The current analysis provides a direct comparison of the cost-effectiveness of pazopanib versus sunitinib from the perspective of the United Kingdom's National Health Service based on data from COMPARZ and other sources.
METHODS
A partitioned-survival analysis model with three health states (alive with no progression, alive with progression, or dead) was used to estimate the incremental cost per quality-adjusted life-year (QALY) gained for pazopanib versus sunitinib over five years (duration of follow-up for final survival analysis in COMPARZ). The proportion of patients in each health state over time was based on Kaplan-Meier distributions for progression-free and overall survival from COMPARZ. Utility values were based on EQ-5D data from the pivotal study of pazopanib versus placebo. Costs were based on medical resource utilisation data from COMPARZ and unit costs from secondary sources. Probabilistic and deterministic sensitivity analyses were conducted to assess uncertainty of model results.
RESULTS
In the base case, pazopanib was estimated to provide more QALYs (0.0565, 95% credible interval [CrI]: -0.0920 to 0.2126) at a lower cost (-£1,061, 95% CrI: -£4,328 to £2,067) versus sunitinib. The probability that pazopanib yields more QALYs than sunitinib was estimated to be 76%. For a threshold value of £30,000 per QALY gained, the probability that pazopanib is cost-effective versus sunitinib was estimated to be 95%. Pazopanib was dominant in most scenarios examined in deterministic sensitivity analyses.
CONCLUSIONS
Pazopanib is likely to be a cost-effective treatment option compared with sunitinib as first-line treatment of mRCC in the United Kingdom.
背景
舒尼替尼和帕唑帕尼是英国国家卫生与临床优化研究所推荐的仅有的两种用于一线治疗局部晚期或转移性肾细胞癌（mRCC）的靶向疗法。在III期COMPARZ试验中，帕唑帕尼与舒尼替尼相比显示出非劣效性疗效和差异化的安全性。本分析基于COMPARZ及其他来源的数据，从英国国家医疗服务体系的角度对帕唑帕尼与舒尼替尼的成本效益进行了直接比较。
方法
采用具有三种健康状态（无进展存活、进展存活或死亡）的分区生存分析模型，以估计帕唑帕尼与舒尼替尼相比在五年内（COMPARZ最终生存分析的随访时长）每获得一个质量调整生命年（QALY）的增量成本。每个健康状态下患者随时间的比例基于COMPARZ中无进展生存期和总生存期的Kaplan-Meier分布。效用值基于帕唑帕尼与安慰剂的关键研究中的EQ-5D数据。成本基于COMPARZ的医疗资源利用数据和二级来源的单位成本。进行了概率性和确定性敏感性分析以评估模型结果的不确定性。
结果
在基础病例中，与舒尼替尼相比，估计帕唑帕尼能以更低的成本（-1,061英镑，95%可信区间[CrI]：-4,328英镑至2,067英镑）提供更多的QALY（0.0565，95% CrI：-0.0920至0.2126）。估计帕唑帕尼比舒尼替尼产生更多QALY的概率为76%。对于每获得一个QALY的阈值为30,000英镑，估计帕唑帕尼相对于舒尼替尼具有成本效益的概率为95%。在确定性敏感性分析中所考察的大多数情况下，帕唑帕尼占主导地位。
结论
在英国，与舒尼替尼相比，帕唑帕尼作为mRCC的一线治疗可能是一种具有成本效益的治疗选择。
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