伴有 BRAF 突变的晚期黑色素瘤患者的治疗序列相关的临床和经济结局。
Clinical and economic outcomes associated with treatment sequences in patients with BRAF-mutant advanced melanoma.
机构信息
Department of Hematology & Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, 44106, USA.
Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
出版信息
Immunotherapy. 2019 Mar;11(4):283-295. doi: 10.2217/imt-2018-0168. Epub 2018 Dec 19.
AIM
The cost-effectiveness of treatment sequences in BRAF-mutant advanced melanoma.
MATERIALS & METHODS: A discrete event simulation model was developed to estimate total costs and health outcomes over a patient's lifetime (30 years). Efficacy was based on the CheckMate 067/069 trials and a matching-adjusted-indirect comparison between immuno-oncology and targeted therapies. Safety, cost (in US dollars; US third-party payer perspective) and health-related quality-of-life inputs were based on published literature.
RESULTS
Estimated survival gain was higher for sequences initiating with anti-PD-1 + anti-CTLA-4 than for anti-PD-1 monotherapy or BRAF+MEK inhibitors. The incremental cost-effectiveness ratio per QALY gained for first-line anti-PD-1 + anti-CTLA-4 was US$54,273 versus first-line anti-PD-1 and $79,124 versus first-line BRAF+MEK inhibitors.
CONCLUSION
Initiating treatment with anti-PD-1 + anti-CTLA-4 was more cost-effective than initiation with anti-PD-1 monotherapy or BRAF+MEK inhibitors.
目的
BRAF 突变型晚期黑色素瘤的治疗方案的成本效益。
材料与方法
建立了一个离散事件模拟模型，以估计患者一生中（30 年）的总费用和健康结果。疗效基于 CheckMate 067/069 试验和免疫肿瘤学与靶向治疗之间的匹配调整间接比较。安全性、成本（以美元计；美国第三方支付者视角）和健康相关生活质量投入均基于已发表的文献。
结果
与抗 PD-1 单药治疗或 BRAF+MEK 抑制剂相比，起始时使用抗 PD-1+抗 CTLA-4 的方案估计生存获益更高。一线抗 PD-1+抗 CTLA-4 每获得一个质量调整生命年的增量成本效益比为 54273 美元，而一线抗 PD-1 为 79124 美元，一线 BRAF+MEK 抑制剂为 79124 美元。
结论
起始时使用抗 PD-1+抗 CTLA-4 治疗比起始时使用抗 PD-1 单药治疗或 BRAF+MEK 抑制剂更具成本效益。
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