University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, 5841 S Maryland Ave, Chicago, IL 60637, USA.
University of Chicago Medicine, Department of Medicine, Section of General Internal Medicine, Center for Chronic Disease Research and Policy, 5841 S Maryland Ave, Chicago, IL 60637, USA.
Gynecol Oncol. 2021 Aug;162(2):249-255. doi: 10.1016/j.ygyno.2021.05.038. Epub 2021 Jun 6.
To determine the cost effectiveness of pembrolizumab/lenvatinib (P/L) versus standard-of-care carboplatin/paclitaxel (C/T) as first-line systemic therapy for patients with advanced/recurrent endometrial cancer.
We designed a Markov model to simulate treatment outcomes for advanced/recurrent endometrial cancer patients whose tumors are either microsatellite stable (MSS) or have high microsatellite instability (MSI-high). We adopted a healthcare sector perspective for the analysis. Model inputs for costs, health utility, and clinical estimates were obtained from the literature including data from GOG0209 and KEYNOTE-146. Primary outcomes included costs of care, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). The time-horizon was three years and the discount rate was 3% annually.
In a MSS cohort, compared to C/T, first-line treatment with P/L increased treatment costs by $212,670 and decreased QALYs by 0.28 per patient. In a MSI-high cohort, compared to C/T, P/L increased costs by $313,487 and increased QALYs by 0.11 per patient, representing an ICER of $2,849,882 per QALY. Sensitivity analyses found that the price of the new drugs was the most important determinant of the ICER and that the price of the new drugs would need to decrease by 85% to $2817 per cycle to reach a $150,000/QALY threshold.
In the MSS model, we found that first-line therapy for advanced or recurrent endometrial cancer with P/L increased costs and worsened outcomes compared to C/T. In the MSI-high model, P/L improved survival and QALYs compared to C/T but was not cost-effective at the current cost of the drugs.
确定帕博利珠单抗/仑伐替尼（P/L）与标准护理卡铂/紫杉醇（C/T）作为晚期/复发性子宫内膜癌患者一线全身治疗的成本效益。
我们设计了一个马尔可夫模型来模拟肿瘤为微卫星稳定（MSS）或具有高微卫星不稳定性（MSI-high）的晚期/复发性子宫内膜癌患者的治疗结果。我们采用医疗保健部门的观点进行分析。成本、健康效用和临床估计的模型输入来自文献，包括来自 GOG0209 和 KEYNOTE-146 的数据。主要结果包括护理成本、质量调整生命年（QALYs）和增量成本效益比（ICER）。时间范围为三年，贴现率为每年 3%。
在 MSS 队列中，与 C/T 相比，一线使用 P/L 治疗会使治疗成本增加 212670 美元，每个患者的 QALY 减少 0.28。在 MSI-high 队列中，与 C/T 相比，P/L 增加了 313487 美元的成本，每个患者增加了 0.11 的 QALY，ICER 为每 QALY 2849882 美元。敏感性分析发现，新药的价格是 ICER 的最重要决定因素，新药的价格需要下降 85%至 2817 美元/周期，才能达到 15 万美元/QALY 的阈值。
在 MSS 模型中，我们发现与 C/T 相比，晚期或复发性子宫内膜癌一线使用 P/L 治疗会增加成本并恶化结局。在 MSI-high 模型中，与 C/T 相比，P/L 改善了生存率和 QALYs，但在当前药物成本下，其并不具有成本效益。
