School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China.
Front Public Health. 2021 Apr 6;9:650392. doi: 10.3389/fpubh.2021.650392. eCollection 2021.
This study evaluated the cost-effectiveness of atezolizumab + chemotherapy vs. chemotherapy as first-line treatment for extensive-stage small-cell lung cancer (SCLC) in the United States (US). The three health states partitioned survival (PS) model was used over the lifetime. Effectiveness and safety data were derived from the IMpower133 trial. The parametric survival model and mixture cure model were used for the atezolizumab + chemotherapy group to explore the long-term uncertainty of the effect of immunotherapy, and the parametric survival model was used for the chemotherapy group. Costs were derived from the pricing files of Medicare and Medicaid Services, and utility values were derived from previous studies. Sensitivity analyses were performed to observe model stability. If the mixture cure model was considered for the intervention group, compared with chemotherapy alone, atezolizumab + chemotherapy yielded an additional 0.11 quality-adjusted life-years (QALYs), with an incremental cost of US$84,257. The incremental cost-utility ratio (ICUR) was US$785,848/QALY. If the parametric survival model was considered for the intervention group, atezolizumab + chemotherapy yielded an additional 0.10 QALYs, with an incremental cost of US$84,257; the ICUR was US$827,610/QALY. In the one-way sensitivity analysis, progression-free (PF) and postprogression (PP) utilities were the main drivers. In the scenario analysis (PF utility = 0.673, PP utility = 0.473), the results showed that the ICUR was US$910,557/QALY and US$965,607/QALY when the mixture cure model and parametric survival model was considered for the intervention group, respectively. In the PSA, the probabilities that atezolizumab + chemotherapy would not be cost-effective were 100% if the willingness-to-pay threshold was US$100,000/QALY. The findings of the present analysis suggest that atezolizumab + chemotherapy is not cost-effective in patients receiving first-line treatment for extensive-stage SCLC in the US.
这项研究评估了阿特珠单抗+化疗与化疗作为美国广泛期小细胞肺癌（SCLC）一线治疗的成本效益。该研究使用了终生的三种健康状态划分生存（PS）模型。疗效和安全性数据来自于 IMpower133 试验。对于阿特珠单抗+化疗组，使用参数生存模型和混合治愈模型来探索免疫治疗效果的长期不确定性，而对于化疗组，则使用参数生存模型。成本来自于医疗保险和医疗补助服务定价文件，效用值来自于先前的研究。进行敏感性分析以观察模型稳定性。如果考虑干预组的混合治愈模型，与单独化疗相比，阿特珠单抗+化疗可额外增加 0.11 个质量调整生命年（QALY），增量成本为 84257 美元。增量成本-效用比（ICUR）为 785848 美元/QALY。如果考虑干预组的参数生存模型，阿特珠单抗+化疗可额外增加 0.10 个 QALY，增量成本为 84257 美元；ICUR 为 827610 美元/QALY。在单因素敏感性分析中，无进展生存期（PF）和后进展（PP）效用是主要驱动因素。在方案分析（PF 效用=0.673，PP 效用=0.473）中，结果表明，当干预组分别考虑混合治愈模型和参数生存模型时，ICUR 分别为 910557 美元/QALY 和 965607 美元/QALY。在 PSA 中，如果意愿支付阈值为 100000 美元/QALY，阿特珠单抗+化疗的概率为 100%不会具有成本效益。本分析的结果表明，阿特珠单抗+化疗在接受广泛期 SCLC 一线治疗的美国患者中不具有成本效益。
