Zhang M, Liu X, Wen F, Wu Q, Zhou K, Bai L, Li Q
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China.
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Clin Oncol (R Coll Radiol). 2022 Mar;34(3):e123-e129. doi: 10.1016/j.clon.2021.10.008. Epub 2021 Nov 2.
The EMPOWER-Lung 1 trial showed that cemiplimab significantly prolongs the duration of progression-free survival and overall survival in advanced non-small cell lung cancer (NSCLC) patients with at least 50% programmed cell death receptor ligand-1 (PD-L1) positivity, yet the financial burden may limit its use. The aim of the present study was to evaluate the cost-effectiveness of cemiplimab versus chemotherapy in a US setting.
A Markov model, with three mutually exclusive health states, was used to compare the expected health outcomes and cost of cemiplimab with chemotherapy. Survival data and transition probabilities were collected from the EMPOWER-Lung 1 trial. Utility values and costs are publicly available from open sources. One-way and probabilistic sensitivity analyses were conducted in both the whole population and subgroups to test the robustness of the parameters and structure.
Treatment of NSCLC with cemiplimab yielded an extra 1.07 quality-adjusted life years (QALYs) at an additional cost of $98 211 compared with chemotherapy, associated with an incremental cost-effectiveness ratio of $91 891/QALY and an incremental net health benefit of 0.087 QALYs at a willingness to pay threshold of $100 000/QALY. The probabilistic sensitivity analysis indicated that cemiplimab provided an 83.2% probability of being cost-effective. One-way sensitivity analysis suggested that the price of cemiplimab was the chief driver in this model. A subgroup analysis showed that cemiplimab was the preferred incremental net health benefit in more than half of the subgroups, including patients with squamous type disease and metastases.
Cemiplimab is a cost-effective option in the first-line treatment of NSCLC in patients who are at least 50% PD-L1 positive from an American perspective.
EMPOWER-Lung 1试验表明，西米普利单抗可显著延长程序性细胞死亡受体配体1（PD-L1）阳性率至少为50%的晚期非小细胞肺癌（NSCLC）患者的无进展生存期和总生存期，但经济负担可能会限制其使用。本研究的目的是评估在美国背景下西米普利单抗与化疗相比的成本效益。
采用具有三种互斥健康状态的马尔可夫模型，比较西米普利单抗与化疗的预期健康结局和成本。生存数据和转移概率取自EMPOWER-Lung 1试验。效用值和成本可从公开来源获得。在总体人群和亚组中进行了单因素和概率敏感性分析，以检验参数和结构的稳健性。
与化疗相比，用西米普利单抗治疗NSCLC可额外获得1.07个质量调整生命年（QALY），但额外成本为98211美元，增量成本效益比为91891美元/QALY，在支付意愿阈值为100000美元/QALY时，增量净健康效益为0.087 QALY。概率敏感性分析表明，西米普利单抗具有成本效益的概率为83.2%。单因素敏感性分析表明，西米普利单抗的价格是该模型的主要驱动因素。亚组分析显示，在超过一半的亚组中，包括鳞状疾病和转移患者，西米普利单抗是首选的增量净健康效益。
从美国的角度来看，西米普利单抗是一线治疗PD-L1阳性率至少为50%的NSCLC患者的具有成本效益的选择。
