Qiao Liu, Zhou Zhen, Zeng Xiaohui, Tan Chongqing
Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.
Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
Front Pharmacol. 2021 Nov 2;12:728440. doi: 10.3389/fphar.2021.728440. eCollection 2021.
Camrelizumab is the first domestic PD-1inhibitor approved to be combined with chemotherapy as a first-line therapy for advanced nonsquamous non-small-cell lung cancer (NSCLC) in China. The purpose of this study was to determine whether using camrelizumab in the first-line setting is cost-effective in China when compared with traditional chemotherapy or the imported PD-1inhibitor pembrolizumab. A Markov model was built to simulate 3-week patient transitions over a 30-year horizon from the perspective of the Chinese healthcare system. Health states included stable disease, first progression, second progression, and death. A direct comparison between first-line camrelizumab in combination with pemetrexed and carboplatin (CPC) and pemetrexed plus carboplatin (PC) was performed by calculating transition probabilities from the CameL trial. An indirect comparison between first-line CPC and pembrolizumab in combination with pemetrexed and platinum (PPP) was performed by calculating transition probabilities using a network meta-analysis. Costs in the Chinese setting were collected from the local public database and literatures. Sensitivity analyses explored the uncertainty around model parameters. In the primary analysis, first-line CPC gained an additional 0.41 quality-adjusted life-years (QALYs) with an incremental cost of $3,486 compared with PC, resulting in an incremental cost-effectiveness ratio (ICER) of $8,378 per QALY gained. In the secondary analysis, first-line PPP yielded an additional 0.10 QALYs at an incremental cost of $6,710, resulting in an ICER of $65,563 per QALY gained. For Chinese patients with advanced nonsquamous NSCLC without targetable genetic aberrations, our primary analysis results supported first-line CPC as a cost-effective treatment compared with traditional PC chemotherapy. The findings of our secondary analysis suggested that first-line PPP would not be a cost-effective option compared with first-line CPC. This analysis provided strong evidence for promoting the widespread use of first-line CPC in China and, to some extent, stimulated the enthusiasm for the development of domestic cancer drugs.
卡瑞利珠单抗是中国首个获批与化疗联合用于晚期非鳞状非小细胞肺癌（NSCLC）一线治疗的国产PD-1抑制剂。本研究的目的是确定在中国一线使用卡瑞利珠单抗与传统化疗或进口PD-1抑制剂帕博利珠单抗相比是否具有成本效益。构建了一个马尔可夫模型，从中国医疗保健系统的角度模拟30年内患者每3周的病情转变。健康状态包括疾病稳定、首次进展、二次进展和死亡。通过计算来自CameL试验的转移概率，对一线卡瑞利珠单抗联合培美曲塞和卡铂（CPC）与培美曲塞加卡铂（PC）进行直接比较。通过使用网络荟萃分析计算转移概率，对一线CPC与帕博利珠单抗联合培美曲塞和铂类（PPP）进行间接比较。中国背景下的成本从当地公共数据库和文献中收集。敏感性分析探讨了模型参数周围的不确定性。在初步分析中，与PC相比，一线CPC多获得了0.41个质量调整生命年（QALYs），增量成本为3486美元，每获得一个QALY的增量成本效益比（ICER）为8378美元。在二次分析中，一线PPP多获得了0.10个QALYs，增量成本为6710美元，每获得一个QALY的ICER为65563美元。对于没有可靶向基因畸变的中国晚期非鳞状NSCLC患者，我们的初步分析结果支持一线CPC作为与传统PC化疗相比具有成本效益的治疗方法。我们二次分析的结果表明，与一线CPC相比，一线PPP不是一个具有成本效益的选择。该分析为推动一线CPC在中国的广泛应用提供了有力证据，并在一定程度上激发了国内抗癌药物研发的热情。
