Department of Radiation Oncology, Cantonal Hospital St. Gallen, Switzerland.
Department of Gynecology, University Hospital Zurich, Switzerland.
Radiother Oncol. 2018 Nov;129(2):257-263. doi: 10.1016/j.radonc.2018.07.017. Epub 2018 Aug 10.
Novel systemic therapies have improved the prognosis of metastatic non-small cell lung cancer (NSCLC), but costs of some of these drugs are a matter of ongoing debate. More recently, local therapies (LT) such as radiotherapy and surgery have been suggested as additional treatment in oligometastatic NSCLC demonstrating an improved progression-free survival (PFS) in a phase II trial compared to maintenance chemotherapy (MC) alone. The aim of this analysis was to assess the cost-effectiveness of local therapies in oligometastatic NSCLC.
We constructed a Markov model comparing the cost-effectiveness of LT versus MC for oligometastatic NSCLC from the Swiss healthcare payer's perspective. Treatment specifications and PFS were based on the phase II trial (NCT01725165). Overall survival (OS) was inferred from a recent phase III trial. Utilities were taken from published data. Primary outcome was the incremental cost-effectiveness-ratio (ICER, costs in Swiss Francs (CHF) per quality-adjusted life-year (QALY) gained).
PFS in the model was 3.8 months for MC and 11.4 months for LT (compared to 3.9 months and 11.9 months in the trial). OS in the model was 15.5 months in both arms. LT was cost-effective with a gain of 0.24 QALYs at an additional cost of CHF 9641, resulting in an ICER of CHF 40,972/QALY gained. Probabilistic sensitivity analyses demonstrated that LT was dominant or cost-effective at a willingness-to-pay threshold of CHF 100,000 per QALY in 61.7% of the simulations.
LT may be cost-effective for selected patients with oligometastatic NSCLC responding to first-line systemic therapy.
新型全身治疗方法改善了转移性非小细胞肺癌（NSCLC）的预后，但其中一些药物的成本仍存在争议。最近，局部治疗（LT），如放疗和手术，被提议作为寡转移性 NSCLC 的附加治疗，与单独维持化疗（MC）相比，在 II 期试验中显示出更好的无进展生存期（PFS）。本分析旨在评估寡转移性 NSCLC 中局部治疗的成本效益。
我们从瑞士医疗保健支付者的角度，构建了一个比较寡转移性 NSCLC 中 LT 与 MC 的成本效益的 Markov 模型。治疗方案和 PFS 基于 II 期试验（NCT01725165）。总生存期（OS）是从最近的 III 期试验中推断出来的。效用来自已发表的数据。主要结果是增量成本效益比（ICER，每获得一个质量调整生命年（QALY）的成本，以瑞士法郎（CHF）表示）。
模型中的 MC 的 PFS 为 3.8 个月，LT 为 11.4 个月（与试验中的 3.9 个月和 11.9 个月相比）。模型中的 OS 在两个治疗组中均为 15.5 个月。LT 在增加 CHF9641 的额外成本下，可获得 0.24 QALYs，具有成本效益，ICER 为每获得一个 QALY 增加 CHF40972。概率敏感性分析表明，在愿意支付的阈值为每 QALY 100000 瑞士法郎的情况下，LT 在 61.7%的模拟中占主导地位或具有成本效益。
对于对一线全身治疗有反应的选定寡转移性 NSCLC 患者，LT 可能具有成本效益。
