Zhang Longfeng, Hang Yongfu, Liu Maobai, Li Na, Cai Hongfu
Department of Thoracic Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fujian Medical University, Fuzhou, China.
Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China.
Front Oncol. 2020 Dec 4;10:602185. doi: 10.3389/fonc.2020.602185. eCollection 2020.
The aim of the present study was to evaluate the cost-effectiveness of durvalumab plus platinum-etoposide platinum-etoposide as first-line treatments for small-cell lung cancer from the perspective of the US payer.
This study established a partition survival model for three health states, metastasis probability, and safety data based on the CASPIAN clinical trial. The health utility value was mainly derived from the published literature. Only direct medical costs were considered. Sensitivity analyses were conducted to assess the robustness of the incremental cost per quality-adjusted life year (QALY).
Durvalumab plus platinum-etoposide increased QALY by 0.220 compared to that observed with platinum-etoposide only. The cost increased by $78,198.75 and the incremental cost per QALY increased by $355,448.86. One-way and probability sensitivity analyses indicated that the model parameters varied within a limited range and had no significant effect on the results.
Although durvalumab plus platinum-etoposide can improve quality of life, it also substantially increases the cost of medical treatment. Under a willingness-to-pay threshold of $100,000, durvalumab does not have a cost-effective comparative advantage.
本研究的目的是从美国医保支付方的角度评估度伐利尤单抗联合铂类-依托泊苷与铂类-依托泊苷作为小细胞肺癌一线治疗方案的成本效益。
本研究基于CASPIAN临床试验建立了一个包含三种健康状态、转移概率和安全性数据的分区生存模型。健康效用值主要来源于已发表的文献。仅考虑直接医疗成本。进行敏感性分析以评估每质量调整生命年（QALY）的增量成本的稳健性。
与仅使用铂类-依托泊苷相比，度伐利尤单抗联合铂类-依托泊苷使QALY增加了0.220。成本增加了78,198.75美元，每QALY的增量成本增加了355,448.86美元。单向和概率敏感性分析表明，模型参数在有限范围内变化，对结果无显著影响。
尽管度伐利尤单抗联合铂类-依托泊苷可改善生活质量，但也大幅增加了医疗成本。在支付意愿阈值为100,000美元的情况下，度伐利尤单抗不具有成本效益比较优势。
