Wu Bin, Ma Fei
Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Road, Chaoyang District, Beijing 100021, China.
Ther Adv Med Oncol. 2020 May 5;12:1758835920916000. doi: 10.1177/1758835920916000. eCollection 2020.
The effectiveness of atezolizumab plus nab-paclitaxel for advanced triple-negative breast cancer (TNBC) has been demonstrated. We aimed to evaluate its cost-effectiveness on advanced TNBC from the US payer perspective.
A Markov model was adopted to project the disease course of newly diagnosed advanced TNBC. The clinical data were gathered from the IMpassion130 trial. Cost and health preference data were derived from the literature. The incremental cost-effectiveness ratio (ICER) was measured, and one-way sensitivity analysis and probabilistic sensitivity analysis were performed for exploring the model uncertainties.
Our results demonstrated that atezolizumab plus nab-paclitaxel augmented nab-paclitaxel therapy cost $104,278 and $149,465 and yielded an additional 0.371 and 0.762 of quality-adjusted life year (QALY) in in all patients with unknown PD-L1 status and subpopulation with PD-L1-positive, respectively, which led to an ICER of $281,448 and $196,073 per QALY gained. In all patients with unknown PD-L1 status, atezolizumab plus nab-paclitaxel treatment guiding by PD-L1 expression testing resulted in an ICER of $183,508 per QALY gained. Atezolizumab plus nab-paclitaxel could maintain a trend of positive incremental net health benefits and >50% probabilities of cost-effectiveness at the threshold of $200,000/QALY in more than half of subgroups with PD-L1-positive. One-way and probabilistic sensitivity analyses revealed the results were most sensitive to the hazard ratios (HRs) of overall survival (OS) of atezolizumab plus nab-paclitaxel nab-paclitaxel treatment.
The atezolizumab plus nab-paclitaxel treatment is likely to be a cost-effective option compared with chemotherapy based on nab-paclitaxel for the patients with PD-L1-positive advanced TNBC.
阿替利珠单抗联合白蛋白紫杉醇治疗晚期三阴性乳腺癌（TNBC）的有效性已得到证实。我们旨在从美国医保支付方的角度评估其对晚期TNBC的成本效益。
采用马尔可夫模型预测新诊断的晚期TNBC的疾病进程。临床数据来自IMpassion130试验。成本和健康偏好数据来自文献。测量增量成本效益比（ICER），并进行单向敏感性分析和概率敏感性分析以探索模型的不确定性。
我们的结果表明，在所有PD-L1状态未知的患者和PD-L1阳性亚组中，阿替利珠单抗联合白蛋白紫杉醇分别使白蛋白紫杉醇治疗成本增加104,278美元和149,465美元，并分别产生额外的0.371和0.762个质量调整生命年（QALY），这导致每获得一个QALY的ICER为281,448美元和196,073美元。在所有PD-L1状态未知的患者中，以PD-L1表达检测为指导的阿替利珠单抗联合白蛋白紫杉醇治疗导致每获得一个QALY的ICER为183,508美元。在超过一半的PD-L1阳性亚组中，阿替利珠单抗联合白蛋白紫杉醇在200,000美元/QALY的阈值下可保持正的增量净健康效益趋势和>50%的成本效益概率。单向和概率敏感性分析表明，结果对阿替利珠单抗联合白蛋白紫杉醇治疗与白蛋白紫杉醇治疗的总生存期（OS）风险比（HRs）最为敏感。
与基于白蛋白紫杉醇的化疗相比，阿替利珠单抗联合白蛋白紫杉醇治疗对于PD-L1阳性晚期TNBC患者可能是一种具有成本效益的选择。
