Luo Xia, Liu Qiao, Zhou Zhen, Yi Lidan, Peng Liubao, Wan Xiaomin, Zeng Xiaohui, Tan Chongqing, Li Sini
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. 2022 Apr 19;13:832215. doi: 10.3389/fphar.2022.832215. eCollection 2022.
To investigate whether LY01008, a locally developed bevacizumab biosimilar agent, is appropriate for widespread use among Chinese advanced or recurrent nonsquamous non-small cell lung cancer (NSCLC) patients, our current study was designed to evaluate the cost-effectiveness of first-line LY01008 combined with platinum-doublet chemotherapy versus chemotherapy alone from the perspective of the Chinese healthcare system. This economic evaluation designed a Markov model to compare the healthcare cost and quality-adjusted life-year (QALY) of first-line LY01008 combined with chemotherapy versus first-line chemotherapy. Transition probabilities, including disease progression, survival, and adverse event (AE)-related discontinuation of first-line treatment, were estimated using data from the clinical trials. Costs and health utilities were derived from local databases, hospitals, and published literature. Our base case analysis and scenario analysis focused on the cost-effectiveness of chemotherapy combined with a clinical trial dosage (15 mg/kg every 3-week cycle) and a real-world dosage (7.5 mg/kg every 3-week cycle) of LY01008, respectively. In the base case analysis, first-line LY01008 combined with chemotherapy was associated with an increase of 0.48 QALYs in effectiveness and an increase of CNY 189,988 (US$ 26,240) in healthcare costs compared with first-line chemotherapy, resulting an incremental cost-effectiveness ratio (ICER) of CNY 375,425 (US$ 54,430)/QALY. In the scenario analysis, first-line LY01008 combined with chemotherapy was associated with a mean healthcare cost of CNY 265,060 (US$ 38,429), resulting an ICER of CNY 221,579 (US$ 32,125/QALY) between first-line LY01008 combined with chemotherapy versus first-line chemotherapy. The parameters that determine the cost of LY01008 have the greatest impact on the cost-effectiveness results. From the perspective of the Chinese healthcare system, first-line LY01008 at a real-world dosage combined with chemotherapy is likely to represent a cost-effective strategy compared with first-line chemotherapy alone for Chinese advanced or recurrent nonsquamous NSCLC patients.
为研究国产贝伐珠单抗生物类似药LY01008是否适合在中国晚期或复发性非鳞状非小细胞肺癌(NSCLC)患者中广泛应用,我们开展了本项研究,旨在从中国医疗体系的角度评估一线使用LY01008联合铂类双药化疗对比单纯化疗的成本效果。本经济评估构建了一个马尔可夫模型,以比较一线使用LY01008联合化疗与一线单纯化疗的医疗成本和质量调整生命年(QALY)。利用临床试验数据估算了转移概率,包括疾病进展、生存以及与不良事件(AE)相关的一线治疗中断情况。成本和健康效用值来源于本地数据库、医院及已发表的文献。我们的基础病例分析和情景分析分别聚焦于化疗联合临床试验剂量(每3周周期15mg/kg)和实际应用剂量(每3周周期7.5mg/kg)的LY01008的成本效果。在基础病例分析中,与一线单纯化疗相比,一线使用LY01008联合化疗有效性增加0.48个QALY,医疗成本增加189,988元人民币(26,240美元),增量成本效果比(ICER)为375,425元人民币(54,430美元)/QALY。在情景分析中,一线使用LY01008联合化疗的平均医疗成本为265,060元人民币(38,429美元),一线使用LY01008联合化疗与一线单纯化疗相比的ICER为221,579元人民币(32,125美元/QALY)。决定LY01008成本的参数对成本效果结果影响最大。从中国医疗体系的角度来看,对于中国晚期或复发性非鳞状NSCLC患者,一线使用实际应用剂量的LYO1008联合化疗与一线单纯化疗相比,可能是一种具有成本效益的策略。