a Hoffmann-La Roche Limited, Global Access , Mississauga , Canada.
b Division of Oncology , William Osler Health System , Toronto , Canada.
J Med Econ. 2019 Jul;22(7):625-637. doi: 10.1080/13696998.2019.1590842. Epub 2019 Mar 25.
To assess the cost-effectiveness in Canada of atezolizumab compared with docetaxel or nivolumab for the treatment of advanced NSCLC after first-line platinum-doublet chemotherapy. A three-state partitioned-survival model was developed. Clinical inputs were obtained from the phase III OAK trial comparing atezolizumab with docetaxel in patients with advanced NSCLC who progressed after first-line platinum-doublet chemotherapy. Overall survival (OS) and progression-free survival (PFS) were extrapolated beyond the trial period using parametric models. A cure model assuming a 1% cure fraction was fitted to the OS data for atezolizumab. Outcomes for nivolumab were informed by a network meta-analysis (NMA) vs atezolizumab. Resource use and costs were informed by clinical expert opinion and published Canadian sources. Utility values were obtained from the OAK trial. The perspective of the analysis was that of the Canadian publicly-funded healthcare system. The base case time horizon was 10 years, and the discount rate was 1.5% annually for both costs and effects. Scenario analyses were performed to test the robustness of the results and all analyses were performed probabilistically. Atezolizumab demonstrated a quality-adjusted life-year (QALY) gain of 0.60 compared with docetaxel at an incremental cost of $85,073, resulting in an incremental cost-effectiveness ratio (ICER) of $142,074/QALY. Atezolizumab dominated nivolumab (regardless of dosing regimen), based on modest differences in both QALYs and costs. Docetaxel was most likely to be cost effective at willingness-to-pay (WTP) thresholds below $125,000/QALY gained, while atezolizumab was most likely to be cost effective beyond this WTP threshold. In most scenario analyses, the results remained robust to changes in parameters. A reduced time horizon and alternative approaches to the NMA had the greatest impact on cost-effectiveness results. Atezolizumab represents a cost-effective therapeutic option in Canada for the treatment of patients with advanced NSCLC who progress after first-line platinum doublet chemotherapy.
评估在加拿大，与多西他赛或纳武单抗相比，阿特珠单抗治疗一线含铂双药化疗后进展的晚期非小细胞肺癌的成本效益。建立了一个三状态分区生存模型。临床数据来自 OAK 三期临床试验，比较了一线含铂双药化疗后进展的晚期非小细胞肺癌患者中阿特珠单抗与多西他赛的疗效。使用参数模型推断试验期外的总生存期（OS）和无进展生存期（PFS）。采用 1%治愈分数的治愈模型拟合 OS 数据。纳武单抗的结果来自网络荟萃分析（NMA）与阿特珠单抗的比较。资源使用和成本由临床专家意见和已发表的加拿大资料提供。效用值从 OAK 试验中获得。分析的观点是加拿大公共资助的医疗保健系统。基本情况时间跨度为 10 年，成本和效果的贴现率均为每年 1.5%。进行了情景分析以检验结果的稳健性，所有分析均采用概率法进行。与多西他赛相比，阿特珠单抗的增量成本为 85073 美元，可获得 0.60 个质量调整生命年（QALY），增量成本效果比（ICER）为 142074 美元/QALY。阿特珠单抗优于纳武单抗（无论剂量方案如何），这主要是因为 QALY 和成本略有差异。在愿意支付（WTP）阈值低于 125000 美元/QALY 获得的情况下，多西他赛最有可能具有成本效益，而在这一 WTP 阈值之外，阿特珠单抗最有可能具有成本效益。在大多数情景分析中，结果对参数变化仍然稳健。缩短时间跨度和对 NMA 的替代方法对成本效益结果的影响最大。在加拿大，对于一线含铂双药化疗后进展的晚期非小细胞肺癌患者，阿特珠单抗是一种具有成本效益的治疗选择。
Expert Rev Pharmacoecon Outcomes Res. 2021-10
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