Department of Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, China.
Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
Front Public Health. 2022 Jul 12;10:913129. doi: 10.3389/fpubh.2022.913129. eCollection 2022.
The purpose of this study was to evaluate the cost-effectiveness and budget impact of fosaprepitant (FosAPR)-containing regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV) among patients receiving high emetogenic chemotherapy (HEC) from the Chinese payer's perspective.
A decision tree model was established to measure the 5-day costs and health outcomes between the APR-containing regimen (aprepitant, granisetron, and dexamethasone) and FosAPR-containing regimen (fosaprepitant, granisetron, and dexamethasone). Clinical data were derived from a randomized, double-blind controlled trial on Chinese inpatients who received HEC. Quality-adjusted life-years (QALYs) were used to estimate the utility outcomes and the incremental cost-effectiveness ratio (ICER) was calculated to assess the economics of FosAPR. A static budget impact model was developed to assess the impact of FosAPR as a new addition to the National Reimbursement Drug List (NRDL) on the medical insurance fund within 3 years in Nanjing, China.
Compared with APR, FosAPR had a mean health-care savings of ¥121.56 but got a reduction of 0.0001815 QALY, resulting in an ICER of ¥669926.19 per QALY. Deterministic sensitivity analysis revealed that the cost of APR was the most influential factor to the ICER. The cost of FosAPR and the complete control rate of the delayed period also had a high impact on the results. According to the probabilistic analysis, the acceptability of FosAPR was more than 80% when the Chinese willingness-to-pay (WTP) was ¥215,999. FosAPR would lead to a 3-year medical insurance payment increase of ¥1.84 million compared with ¥1.49 million before FosAPR entered NRDL in Nanjing. The total budget increased with a cumulative cost of ¥694,829 and covered an additional 341 patients who benefited from FosAPR in Nanjing. Deterministic sensitivity analysis showed that the model of budget impact analysis was stable.
FosAPR had a similar treatment effect to APR but was cost-effective in China at the current WTP threshold. The total budget of medical insurance payments of Nanjing slightly increased year by year after the inclusion of FosAPR. Its inclusion in the NRDL would be acceptable and also expand the coverage of patients who benefited from FosAPR.
本研究旨在从中国支付方的角度评估含有福沙吡坦（fosaprepitant，FosAPR）的方案预防接受高致吐性化疗（HEC）的患者化疗所致恶心和呕吐（CINV）的成本效果和预算影响。
采用决策树模型来衡量 APR 方案（阿瑞匹坦、格拉司琼和地塞米松）和 FosAPR 方案（福沙吡坦、格拉司琼和地塞米松）之间 5 天的成本和健康结果。临床数据来自于一项在中国住院患者中进行的 HEC 的随机、双盲对照试验。质量调整生命年（QALY）用于评估效用结果，增量成本效果比（ICER）用于评估 FosAPR 的经济学。采用静态预算影响模型评估 FosAPR 作为新增药物纳入中国南京国家医保目录（NRDL）对医保基金的 3 年内影响。
与 APR 相比，FosAPR 具有 121.56 元的平均医疗保健节省，但 QALY 减少了 0.0001815，导致每 QALY 的 ICER 为 669926.19 元。确定性敏感性分析表明，APR 的成本是影响 ICER 的最关键因素。FosAPR 的成本和延迟期完全控制率也对结果有较大影响。根据概率分析，当中国意愿支付（WTP）为 215999 元时，FosAPR 的可接受性超过 80%。与 FosAPR 纳入 NRDL 之前相比，FosAPR 将导致南京医保 3 年内支付增加 184 万元，而增加的总额为 694829 元，覆盖了南京额外的 341 名受益于 FosAPR 的患者。确定性敏感性分析表明，预算影响分析模型是稳定的。
FosAPR 在中国具有与 APR 相似的治疗效果，但在当前的 WTP 阈值下具有成本效果。纳入 FosAPR 后，南京医保总预算逐年略有增加。将其纳入 NRDL 将是可以接受的，并且还将扩大受益于 FosAPR 的患者的覆盖范围。
