Chen Jigang, Han Mingyang, Liu Aihua, Shi Bo
Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2021 Oct 28;11:734594. doi: 10.3389/fonc.2021.734594. eCollection 2021.
The effectiveness of Sacituzumab Govitecan (SG) for metastatic triple-negative breast cancer (mTNBC) has been demonstrated. We aimed to evaluate its cost-effectiveness on mTNBC from the Chinese and United States (US) perspective.
A partitioned survival model was developed to compare the cost and effectiveness of SG single-agent chemotherapy based on clinical data from the ASCENT phase 3 randomized trial. Cost and utility data were obtained from the literature. The incremental cost-effectiveness ratio (ICER) was measured, and one-way and probabilistic sensitivity analyses (PSA) were performed to observe model stability. A Markov model was constructed to validate the results.
In China, SG yielded an additional 0.35 quality-adjusted life-year (QALY) at an additional cost of Chinese Renminbi ¥2257842. The ICER was ¥6375856 ($924037)/QALY. In the US, SG yielded the same additional QALY at an extra cost of $175393 and the ICER was $494479/QALY. Similar results were obtained from the Markov model. One-way sensitivity analyses showed that SG price had the greatest impact on the ICER. PSA showed the probability of SG to be cost-effective when compared with chemotherapy was zero at the current willing-to-pay threshold of ¥217341/QALY and $150000/QALY in China and the US, respectively. The probability of cost-effectiveness of SG would approximate 50% if its price was reduced to ¥10.44/mg in China and $3.65/mg in the US.
SG is unlikely to be a cost-effective treatment of mTNBC at the current price both in China and the US.
已证实戈沙妥珠单抗（SG）对转移性三阴性乳腺癌（mTNBC）有效。我们旨在从中美两国的角度评估其对mTNBC的成本效益。
基于ASCENT 3期随机试验的临床数据，建立了一个分区生存模型，以比较SG单药化疗的成本和效果。成本和效用数据来自文献。测量增量成本效益比（ICER），并进行单因素和概率敏感性分析（PSA）以观察模型稳定性。构建马尔可夫模型以验证结果。
在中国，SG额外产生了0.35个质量调整生命年（QALY），额外成本为人民币2257842元。ICER为6375856元/ QALY（924037美元/ QALY）。在美国，SG产生了相同的额外QALY，额外成本为175393美元，ICER为494479美元/ QALY。马尔可夫模型得到了类似的结果。单因素敏感性分析表明，SG价格对ICER影响最大。PSA显示，在中国和美国目前分别为217341元/ QALY和150000美元/ QALY的支付意愿阈值下，与化疗相比，SG具有成本效益的概率为零。如果在中国将其价格降至10.44元/毫克，在美国降至3.65元/毫克，SG具有成本效益的概率将接近50%。
在中国和美国，以目前的价格，SG不太可能成为mTNBC的具有成本效益的治疗方法。
