Zhang Longfeng, Li Na, Liu Maobai, Zheng Bin, Wu Zhijuan, Cai Hongfu
Department of Thoracic Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian Province, People's Republic of China.
Department of Pharmacy, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, Fujian Province, People's Republic of China.
Cancer Manag Res. 2021 May 28;13:4263-4270. doi: 10.2147/CMAR.S293983. eCollection 2021.
The objective of the study was to evaluate the economics of dacomitinib and gefitinib in the first-line treatments for EGFR-positive advanced or metastatic non-small cell lung cancer (NSCLC) from a US payer perspective.
We developed the partition survival model to compare the lifetime cost and health outcomes of dacomitinib versus gefitinib. Transition probabilities were collected from the ARCHER 1050 trial. The model only considered the direct medical costs. Utility values were taken from published research.
Compared to gefitinib, dacomitinib increased 0.706 QALY and the cost increased $232,359.32. The incremental cost-effectiveness ratio (ICER) was $329,120.85 per QALY in the base case. One-way sensitivity analysis showed that the cost of drugs and the utility had more influence on the results than other parameters. Probability sensitivity analysis reflected that the parameters had little effect on the results.
Dacomitinib could improve the health benefits and increase the overall costs. In this simulation, dacomitinib is not likely to be economical for first-line therapy of EGFR-mutated NSCLC.
本研究的目的是从美国医保支付方的角度评估达可替尼和吉非替尼用于表皮生长因子受体（EGFR）阳性的晚期或转移性非小细胞肺癌（NSCLC）一线治疗的经济性。
我们建立了分区生存模型，以比较达可替尼与吉非替尼的终身成本和健康结局。转移概率取自ARCHER 1050试验。该模型仅考虑直接医疗成本。效用值取自已发表的研究。
与吉非替尼相比，达可替尼增加了0.706个质量调整生命年（QALY），成本增加了232,359.32美元。在基础案例中，增量成本效益比（ICER）为每QALY 329,120.85美元。单向敏感性分析表明，药物成本和效用对结果的影响大于其他参数。概率敏感性分析表明，各参数对结果影响较小。
达可替尼可改善健康效益，但会增加总体成本。在本模拟研究中，达可替尼用于EGFR突变的NSCLC一线治疗不太可能具有经济性。
