Department of Radiation Oncology, An-Nan Hospital, China Medical University, Tainan, Taiwan.
Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
Expert Rev Pharmacoecon Outcomes Res. 2021 Jun;21(3):489-495. doi: 10.1080/14737167.2021.1890585. Epub 2021 Mar 17.
This study aimed to estimate the cost-utility of stereotactic body radiotherapy (SBRT) plus cetuximab for patients with previously irradiated recurrent squamous cell carcinoma of the head and neck.
We constructed a Markov health-state transition model to simulate costs and clinical outcomes of recurrent squamous cell carcinoma of the head and neck. Model parameters were derived from the published literature and the National Health Insurance Administration reimbursement price list. Incremental cost-effectiveness ratio and the net monetary benefit were calculated from a health payer perspective. The impact of uncertainty was modeled with one-way and probabilistic sensitivity analyses.
In the base-case, SBRT plus cetuximab compared to SBRT alone resulted in an ICER of NT$ 840,455 per QALY gained. In the one-way sensitivity analysis, the utility of progression-free state for patients treated with SBRT plus cetuximab or SBRT alone and the cost of progression-free survival for SBRT+Cet were the most sensitive parameters in the model. Probabilistic sensitivity analysis showed that the probability of cost-effectiveness at a willingness-to-pay threshold of NT$ 2,252,340 per QALY was 100% for SBRT plus cetuximab but 0% for SBRT alone.
This study showed that SBRT+Cet was cost-effective and benefited patients with previously irradiated rSCCHN.
本研究旨在评估立体定向体部放疗（SBRT）联合西妥昔单抗用于治疗既往放疗后复发性头颈部鳞状细胞癌患者的成本效用。
我们构建了一个马尔可夫健康状态转移模型，以模拟复发性头颈部鳞状细胞癌的成本和临床结果。模型参数来自已发表的文献和全民健康保险管理局的报销价格清单。从卫生支付者的角度计算增量成本效益比和净货币收益。采用单因素敏感性分析和概率敏感性分析来模拟不确定性的影响。
在基础情况下，SBRT 联合西妥昔单抗与 SBRT 单药治疗相比，每增加一个质量调整生命年（QALY）的增量成本效益比为新台币 840,455 元。在单因素敏感性分析中，SBRT 联合西妥昔单抗或 SBRT 单药治疗患者无进展状态的效用以及 SBRT+Cet 无进展生存期的成本是模型中最敏感的参数。概率敏感性分析显示，在新台币 2,252,340 元/QALY 的意愿支付阈值下，SBRT 联合西妥昔单抗的成本效益概率为 100%，而 SBRT 单药治疗的概率为 0%。
本研究表明，SBRT+Cet 具有成本效益，有益于既往放疗后复发性头颈部鳞状细胞癌患者。
