Chua A, Perrin A, Ricci J F, Neary M P, Thabane M
Analytica Laser, New York, NY, U.S.A.
Wellmera AG, Basel, Switzerland.
Curr Oncol. 2018 Feb;25(1):32-40. doi: 10.3747/co.25.3532. Epub 2018 Feb 28.
In 2016, everolimus was approved by Health Canada for the treatment of unresectable, locally advanced or metastatic, well-differentiated, non-functional, neuroendocrine tumours (NET) of gastrointestinal (GI) or lung origin in adult patients with progressive disease. This analysis evaluated the cost-effectiveness of everolimus in this setting from a Canadian societal perspective.
A partitioned survival model was developed to compare the cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained of everolimus plus best supportive care (BSC) versus BSC alone in patients with advanced or metastatic NET of GI or lung origin. Model health states included stable disease, disease progression, and death. Efficacy inputs were based on the RADIANT-4 trial and utilities were mapped from quality-of-life data retrieved from RADIANT-4. Resource utilization inputs were derived from a Canadian physician survey, while cost inputs were obtained from official reimbursement lists from Ontario and other published sources. Costs and efficacy outcomes were discounted 5% annually over a 10-year time horizon, and sensitivity analyses were conducted to test the robustness of the base case results.
Everolimus had an incremental gain of 0.616 QALYs (0.823 LYs) and CA$89,795 resulting in an incremental cost-effectiveness ratio of CA$145,670 per QALY gained (CA$109,166 per LY gained). The probability of cost-effectiveness was 52.1% at a willingness to pay (WTP) threshold of CA$150,000 per QALY.
Results of the probabilistic sensitivity analysis indicate that everolimus has a 52.1% probability of being cost-effective at a WTP threshold of CA$150,000 per QALY gained in Canada.
2016年，依维莫司获加拿大卫生部批准，用于治疗患有进展性疾病的成年患者不可切除、局部晚期或转移性、高分化、无功能性的胃肠道（GI）或肺源性神经内分泌肿瘤（NET）。本分析从加拿大社会角度评估了依维莫司在此种情况下的成本效益。
构建了一个分区生存模型，以比较依维莫司联合最佳支持治疗（BSC）与单纯BSC相比，在患有晚期或转移性GI或肺源性NET患者中每获得一个生命年（LY）的成本以及每获得一个质量调整生命年（QALY）的成本。模型健康状态包括疾病稳定、疾病进展和死亡。疗效数据基于RADIANT - 4试验，效用值根据从RADIANT - 4获取的生活质量数据进行映射。资源利用数据来自加拿大医生调查，而成本数据则从安大略省的官方报销清单及其他已发表来源获取。在10年时间范围内，成本和疗效结果按每年5%进行贴现，并进行敏感性分析以检验基础病例结果的稳健性。
依维莫司增加了0.616个QALY（0.823个LY），成本增加89,795加元，导致每获得一个QALY的增量成本效益比为145,670加元（每获得一个LY的增量成本效益比为109,166加元）。在每QALY支付意愿（WTP）阈值为150,000加元时，成本效益概率为52.1%。
概率敏感性分析结果表明，在加拿大每获得一个QALY支付意愿阈值为150,000加元时，依维莫司具有52.1%的成本效益概率。
