阿替利珠单抗联合白蛋白紫杉醇一线治疗晚期三阴性乳腺癌的成本效果分析。
First-Line Treatment With Atezolizumab Plus Nab-Paclitaxel for Advanced Triple-Negative Breast Cancer: A Cost-Effectiveness Analysis.
机构信息
Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province.
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu Province, People's Republic of China.
出版信息
Am J Clin Oncol. 2020 May;43(5):340-348. doi: 10.1097/COC.0000000000000671.
OBJECTIVE
The authors conducted a cost-effectiveness analysis incorporating recent phase III clinical trial (IMpassion130) data to evaluate the cost-effectiveness of atezolizumab in combination with nab-paclitaxel (AnP) against nab-paclitaxel alone as the first-line treatment for advanced triple-negative breast cancer in developed and developing countries.
MATERIALS AND METHODS
A decision-analytic Markov model was developed using IMpassion130 data to evaluate the cost-effectiveness of AnP over a lifetime from the US health care payer and Chinese health care system perspective. Model inputs were derived from IMpassion130 and published literature. The primary outcomes of the model were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using univariate and probabilistic sensitivity analyses.
RESULTS
For the intention-to-treat (ITT) population, the projected mean outcome was better with AnP (1.41 QALYs) than with nab-paclitaxel alone (0.99 QALYs). Similar results were obtained for the programmed death ligand 1 (PD-L1)-positive population, with the obtained mean outcomes of 1.66 and 0.88 QALYs, respectively. For the Unites States, the ICER values comparing AnP with nab-paclitaxel were US$331,996.89 and US$229,359.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. For China, the ICER values were US$106,339.26 and US$72,971.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. The univariate sensitivity analysis indicated that the price of atezolizumab was the most influential factor in our study. AnP had 0% cost-effectiveness at the willingness-to-pay thresholds of US$150,000/QALY in the United States and US$29,383/QALY in China.
CONCLUSION
AnP is not a cost-effective choice as the first-line treatment for advanced triple-negative breast cancer in the United States and China.
目的
作者进行了一项成本效益分析，纳入了最近的 III 期临床试验（IMpassion130）数据，以评估阿特珠单抗联合 nab-紫杉醇（AnP）与单独使用 nab-紫杉醇作为先进三阴性乳腺癌的一线治疗在发达国家和发展中国家的成本效益。
材料和方法
使用来自 IMpassion130 的数据，通过决策分析马尔可夫模型，从美国医疗保健支付者和中国医疗保健系统的角度评估 AnP 在一生中的成本效益。模型输入来自 IMpassion130 和已发表的文献。该模型的主要结果是质量调整生命年（QALYs）和增量成本效益比（ICERs）。使用单变量和概率敏感性分析来解决不确定性。
结果
对于意向治疗（ITT）人群，AnP 的预测平均结果（1.41 QALYs）优于单独使用 nab-紫杉醇（0.99 QALYs）。对于程序性死亡配体 1（PD-L1）阳性人群，获得的平均结果分别为 1.66 和 0.88 QALYs。对于美国，与 nab-紫杉醇相比，AnP 的 ICER 值分别为每获得一个 QALY 的 331,996.89 美元和 229,359.88 美元，适用于 ITT 和 PD-L1 阳性人群。对于中国，AnP 的 ICER 值分别为每获得一个 QALY 的 106,339.26 美元和 72,971.88 美元，适用于 ITT 和 PD-L1 阳性人群。单变量敏感性分析表明，在我们的研究中，阿特珠单抗的价格是最具影响力的因素。在美国，AnP 的成本效益比为 150,000 美元/QALY，在中国为 29,383 美元/QALY，AnP 的成本效益比为 0%。
结论
在美国和中国，AnP 不是先进三阴性乳腺癌一线治疗的一种具有成本效益的选择。
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