一线帕博利珠单抗联合化疗治疗广泛期小细胞肺癌：一项基于美国的成本效益分析。

First-line pembrolizumab plus chemotherapy for extensive-stage small-cell lung cancer: a United States-based cost-effectiveness analysis.

作者信息

Zhu Youwen, Hu Huabin, Ding Dong, Li Shuosha, Liao Mengting, Shi Yin, Huang Jin

机构信息

Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.

Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.

出版信息

Cost Eff Resour Alloc. 2021 Dec 4;19(1):77. doi: 10.1186/s12962-021-00329-w.

DOI:10.1186/s12962-021-00329-w

PMID:34863203

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8642846/

Abstract

BACKGROUND

The clinical trial of Keynote-604 showed that pembrolizumab plus chemotherapy could generate clinical benefits for extensive-stage small-cell lung cancer (ES-SCLC). We aim to assess the efficacy and cost of pembrolizumab combined with chemotherapy in the first-line treatment setting of ES-SCLC from the United States (US) payers' perspective.

METHODS

A synthetical Markov model was used to evaluate cost and effectiveness of pembrolizumab plus platinum-etoposide(EP) versus EP in first-line therapy for ES-SCLC from the data of Keynote-604. Lifetime costs life-years(LYs), quality adjusted LYs(QALYs) and incremental cost-effectiveness ratios(ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed. Furthermore, we performed subgroup analysis.

RESULTS

Pembrolizumab plus EP resulted in additional 0.18 QALYs(0.32 LYs) and corresponding incremental costs $113,625, resulting an ICER of $647,509 per QALY versus EP. The price of pembrolizumab had a significant impact on ICER. Probabilistic sensitivity analysis indicated that pembrolizumab combined chemotherapy may become a cost-effective option with a probability of 0%. Besides, subgroup analysis suggested that all subgroups were not cost-effective.

CONCLUSION

From the perspective of the US payer, pembrolizumab plus EP is not a cost-effective option for first-line treatment patients with ES-SCLC at a WTP threshold of $150,000 per QALY.

摘要

背景

Keynote-604临床试验表明，帕博利珠单抗联合化疗可为广泛期小细胞肺癌（ES-SCLC）带来临床益处。我们旨在从美国医保支付方的角度评估帕博利珠单抗联合化疗用于ES-SCLC一线治疗的疗效和成本。

方法

使用综合马尔可夫模型，根据Keynote-604的数据评估帕博利珠单抗联合铂类-依托泊苷（EP）与EP用于ES-SCLC一线治疗的成本和效果。估计了终生成本、生命年（LYs）、质量调整生命年（QALYs）和增量成本-效果比（ICERs）。进行了单向和概率敏感性分析。此外，我们还进行了亚组分析。

结果

帕博利珠单抗联合EP可增加0.18个QALYs（0.32个LYs），相应的增量成本为113,625美元，与EP相比，ICER为每QALY 647,509美元。帕博利珠单抗的价格对ICER有显著影响。概率敏感性分析表明，帕博利珠单抗联合化疗成为具有成本效益的选择的概率为0%。此外，亚组分析表明所有亚组均不具有成本效益。