在中国，呋喹替尼对比瑞戈非尼作为三线治疗转移性结直肠癌的成本效果分析。
Cost-effectiveness analysis of fruquintinib versus regorafenib as the third-line therapy for metastatic colorectal cancer in China.
机构信息
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China.
出版信息
J Med Econ. 2021 Jan-Dec;24(1):339-344. doi: 10.1080/13696998.2021.1888743.
OBJECTIVES
The aim of this study is to assess the cost-effectiveness of fruquintinib compared to regorafenib as third-line treatment for patients with metastatic colorectal cancer (mCRC) in China.
METHODS
A three-state Markov model with monthly cycle was constructed to estimate lifetime incremental cost-effectiveness ratio (ICER) of fruquintinib versus regorafenib as third-line treatment for patients with mCRC from Chinese health care perspective. Survival analysis was applied to calculate transition probabilities using the data from the clinical trials FRESCO and CONCUR, which were also the data sources accessing probabilities of adverse events. Background mortality rate and drug costs were derived from government published data. Costs for medical services were obtained from real-world data and published literatures. Utilities applied to calculate the quality-adjusted life years (QALYs) were obtained from literature review. One-way sensitivity analysis and probabilistic sensitivity analysis were adopted to verify the robustness of the results.
RESULTS
Fruquintinib provided 0.74 QALYs at a cost of CNY 151,058 (USD 22,888), whereas regorafenib provided 0.79 QALYs at a cost of CNY 226,657 (USD 32,224). Compared to fruquintinib, the ICER of regorafenib was CNY 1,529,197/QALY (USD 231,697/QALY) from Chinese health care perspective, which was above the triple GDP per capita of China in 2019 (CNY 212,676) (USD 32,224) as the threshold to define the cost-effectiveness. One-way sensitivity analysis showed the results were generally robust. Cost-effectiveness acceptability curves derived from probabilistic sensitivity analysis demonstrated the probability that fruquintinib was more cost-effective was 100% when the threshold was the triple GDP per capita of China.
CONCLUSIONS
Compared to regorafenib, fruquintinib, which leads to forego about 0.05 QALYs and save about CNY 75,599 (USD 11,454), is a cost-effective choice as the third-line treatment for patients with mCRC in China.
目的
本研究旨在评估呋喹替尼对比regorafenib 作为三线治疗转移性结直肠癌（mCRC）患者的成本效果。
方法
采用三状态 Markov 模型，以月为周期，从中国卫生保健角度评估 fruquintinib 对比 regorafenib 作为三线治疗 mCRC 患者的增量成本效果比值（ICER）。采用 FRESCO 和 CONCUR 临床试验数据进行生存分析，以计算转移概率，这些数据也是评估不良反应发生概率的数据源。背景死亡率和药物成本来自政府公布的数据。医疗服务成本来源于真实世界数据和已发表文献。应用文献回顾获得质量调整生命年（QALY）的效用值。采用单因素敏感性分析和概率敏感性分析验证结果的稳健性。
结果
与 fruquintinib 相比，regorafenib 治疗的成本为 CNY 151,058（USD 22,888），提供 0.74 个 QALYs；而 fruquintinib 治疗的成本为 CNY 226,657（USD 32,224），提供 0.79 个 QALYs。从中国卫生保健角度来看，与 fruquintinib 相比，regorafenib 的 ICER 为 CNY 1,529,197/QALY（USD 231,697/QALY），高于 2019 年中国人均国内生产总值（GDP）的三倍（CNY 212,676）（USD 32,224），即定义成本效果的阈值。单因素敏感性分析结果普遍稳健。概率敏感性分析得出的成本效果接受曲线表明，当阈值为人均 GDP 的三倍时，fruquintinib 更具成本效果的概率为 100%。
结论
与 regorafenib 相比，fruquintinib 作为三线治疗 mCRC 患者的选择，可放弃约 0.05 个 QALY，节省约 CNY 75,599（USD 11,454），具有成本效果。
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