Zhu Chen, Xing Xiao-Xuan, Wu Bin, Liang Gang, Han Gang, Lin Cai-Xia, Fang Hong-Mei
Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China.
Front Pharmacol. 2021 Dec 24;12:735536. doi: 10.3389/fphar.2021.735536. eCollection 2021.
The CAMEL clinical trial (412 patients were randomly assigned to either camrelizumab plus chemotherapy (n = 205) or chemotherapy alone (n = 207)) demonstrated that camrelizumab plus chemotherapy (CC) improved the overall survival time (OS) and progression-free survival time (PFS) of patients with metastatic nonsquamous non-small cell lung cancer (non-sq NSCLC) without epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations (EGFRm and ALKm) vs. chemotherapy (C) alone. Our objective was to conduct a cost-effectiveness analysis of CC vs. C from a perspective of health - care system in China with a lifetime horizon to identify whether it will be cost-effective. A partitioned survival model (PSM) was applied for patients with IIIB-IV non-sq NSCLC without EGFRm and ALKm. Transition parameters and proportions of three health states were derived from the CAMEL trial. The model was designed using a lifetime horizon, a 21-day cycle, and a 5% discount rate of costs and outcomes. It was deemed cost-effective in China if the incremental cost-effectiveness ratio (ICER) value is less than $32,457 per quality adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses were performed to verify the influence of parameter uncertainty on the results. In the base-case analysis, we found that the ICER of CC compared with C is $-7,382.72/QALY which meant that CC had lower costs and better outcomes. The results of the sensitivity analyses demonstrated that the result was robust for the ICERs never transcending the willingness-to-pay (WTP) threshold. Camrelizumab plus chemotherapy is an obviously cost-effective therapeutic regime for patients of IIIB-IV non-sq NSCLC without EGFRm and ALKm in China at a $32,457 WTP threshold.
CAMEI临床试验（412例患者被随机分为卡瑞利珠单抗联合化疗组（n = 205）或单纯化疗组（n = 207））表明，与单纯化疗相比，卡瑞利珠单抗联合化疗（CC）可改善无表皮生长因子受体（EGFR）或间变性淋巴瘤激酶（ALK）突变（EGFRm和ALKm）的转移性非鳞状非小细胞肺癌（非鳞状NSCLC）患者的总生存时间（OS）和无进展生存时间（PFS）。我们的目标是从中国医疗保健系统的角度进行CC与单纯化疗的成本效益分析，以确定其是否具有成本效益。对无EGFRm和ALKm的IIIB-IV期非鳞状NSCLC患者应用了分区生存模型（PSM）。三个健康状态的转移参数和比例来自CAMEI试验。该模型的设计采用终身视角、21天周期以及5%的成本和结果贴现率。如果增量成本效益比（ICER）值低于每质量调整生命年（QALY）32,457美元，则在中国被认为具有成本效益。进行了确定性和概率敏感性分析，以验证参数不确定性对结果的影响。在基础案例分析中，我们发现CC与单纯化疗相比的ICER为-7,382.72美元/QALY，这意味着CC成本更低且结果更好。敏感性分析结果表明，ICER从未超过支付意愿（WTP）阈值，结果具有稳健性。在支付意愿阈值为32,457美元的情况下，卡瑞利珠单抗联合化疗对于中国无EGFRm和ALKm的IIIB-IV期非鳞状NSCLC患者而言是一种明显具有成本效益的治疗方案。
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