Bai Yongrui, Xu Yuejuan, Wu Bin
Department of Radiation Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Clinical Oncology, The Second Hospital of Nanjing Affiliated with the Medical School of South East University, Zhongfu Road 1, Nanjing, China.
Gastroenterol Res Pract. 2017;2017:2816737. doi: 10.1155/2017/2816737. Epub 2017 Nov 26.
This study evaluated the cost-effectiveness of apatinib in patients with chemotherapy-refractory mGC.
A Markov model was developed to simulate the clinical course of typical patients with chemotherapy-refractory metastatic gastric cancer (mGC). We estimated the 10-year quality-adjusted life-years (QALY), costs, and incremental cost-effectiveness ratios (ICER). Model inputs were derived from the published literature and government sources. Direct costs were estimated from the perspective of the Chinese health insurance system. A scenario analysis for a Patient Assistance Programme (PAP) was performed.
Baseline analysis showed that apatinib increased the cost and QALYs by $7859 and 0.192, respectively, relative to conventional chemotherapy, resulting in an ICER of $40,997/QALY gained. When PAP was available, the ICER was $21,132/QALY. Probabilistic sensitivity analyses confirmed that apatinib with PAP achieved nearly 65% likelihood of cost-effectiveness at the threshold of $22,200. One-way sensitivity analyses demonstrated that the utility of progression-free survival was the most influential factor on the robustness of the model. Budget impact analysis estimated that the annual increase in fiscal expenditures would be approximately 0.45 million dollars.
Our analysis suggests that apatinib is likely cost-effective in patients with chemotherapy-refractory mGC when PAP is available.
本研究评估了阿帕替尼用于化疗难治性转移性胃癌（mGC）患者的成本效益。
建立马尔可夫模型以模拟典型化疗难治性转移性胃癌患者的临床病程。我们估算了10年质量调整生命年（QALY）、成本及增量成本效益比（ICER）。模型输入数据源自已发表文献和政府资料。直接成本从中国医疗保险系统的角度进行估算。对患者援助计划（PAP）进行了情景分析。
基线分析显示，相对于传统化疗，阿帕替尼分别使成本和QALY增加了7859美元和0.192，导致获得每QALY的ICER为40,997美元。当有PAP时，ICER为21,132美元/QALY。概率敏感性分析证实，在22,200美元的阈值下，阿帕替尼联合PAP实现成本效益的可能性接近65%。单向敏感性分析表明，无进展生存期的效用是对模型稳健性影响最大的因素。预算影响分析估计，财政支出的年度增加额约为45万美元。
我们的分析表明，当有PAP时，阿帕替尼用于化疗难治性mGC患者可能具有成本效益。
