地加瑞克与亮丙瑞林治疗中国前列腺癌的成本效用分析。
Degarelix vs. leuprorelin for the treatment of prostate cancer in China: A cost-utility analysis.
机构信息
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
The Research Center of National Drug Policy and Ecosystem, China Pharmaceutical University, Nanjing, China.
出版信息
Front Public Health. 2022 Jul 18;10:942800. doi: 10.3389/fpubh.2022.942800. eCollection 2022.
OBJECTIVE
To explore the cost-effectiveness of degarelix acetate for injection (degarelix) compared to leuprorelin in prostate cancer (Pca) castration treatment from Chinese healthcare system perspective.
METHODS
A Markov model, adapted from the one established in Finland was conducted for the cost-effectiveness analysis of degarelix and leuprorelin for Pca treatment. The main data were derived from global phase III clinical trials of degarelix (CS21), published study and expert surveys. Outcomes, utility and costs of prostate cancer patients were calculated on a 30-year time horizon. The CS21 study based population of intention-to-treat (ITT) population and three scenarios were modeled. Taking three times of the Gross domestic product (GDP) per capita (242,928 yuan, 2021) as the acceptable threshold for cost-effectiveness. One-way and probabilistic sensitivity analyses were performed on key parameters, including transition probabilities, costs, utility, and discount rate to test the robustness of the model.
RESULTS
Base case analysis for ITT population revealed that total costs of degarelix and leuprorelin were 566,226 yuan and 489,693 yuan, while the total quality-adjusted life years (QALYs) were 5.19 and 4.51 during the 30-year time horizon, resulting an incremental cost effectiveness ratio (ICER) of 112,674 yuan/QALY which was 1.39 times the GDP per capita, lower than willingness-to-pay level of three times the GDP per capita. The results for scenario analyses revealed that compared to leuprorelin, degarelix for Pca treatment in China was cost-effective. One-way sensitivity analysis showed that the model was most sensitive to price of 80 mg degarelix, utility of 1st-line therapy, hazard ratio of PSA recurrence, price of 3.75 mg leuprorelin, response rate of docetaxel per cycle, and discount rate of cost. In probabilistic sensitivity analysis, compared to leuprorelin, the probability of degarelix to be cost-effective was 53 and 81% for willingness-to-pay threshold of one and three times the GDP per capita.
CONCLUSION
Compared to leuprorelin, degarelix for prostate cancer treatment is cost-effective. Moreover, scenario, one-way, and probabilistic sensitivity analyses revealed that the model was robust.
目的
从中国医疗保健系统的角度出发，探讨醋酸加尼瑞克（degarelix）注射剂（degarelix）与亮丙瑞林（leuprorelin）治疗前列腺癌（Pca）去势治疗的成本效益。
方法
采用从芬兰建立的模型改编的 Markov 模型，对 degarelix 和 leuprorelin 治疗 Pca 的成本效益进行了分析。主要数据来源于 degarelix（CS21）的全球 III 期临床试验、已发表的研究和专家调查。对前列腺癌患者的结果、效用和成本进行了 30 年的时间预测。根据意向治疗（ITT）人群和三种情况对 CS21 研究的人群进行了建模。以三次人均国内生产总值（GDP）（2021 年为 242928 元）作为成本效益的可接受阈值。对转移概率、成本、效用和贴现率等关键参数进行了单向和概率敏感性分析，以检验模型的稳健性。
结果
对 ITT 人群的基本情况分析表明，degarelix 和 leuprorelin 的总费用分别为 566226 元和 489693 元，30 年时间内的总质量调整生命年（QALY）分别为 5.19 和 4.51，增量成本效益比（ICER）为 112674 元/QALY，是人均 GDP 的 1.39 倍，低于人均 GDP 的三倍。方案分析的结果表明，与 leuprorelin 相比，degarelix 在中国治疗前列腺癌是具有成本效益的。单向敏感性分析表明，该模型对 80mg degarelix 的价格、一线治疗的效用、PSA 复发的危险比、3.75mg leuprorelin 的价格、每周期多西他赛的反应率和成本的贴现率最为敏感。在概率敏感性分析中，与 leuprorelin 相比，degarelix 的成本效益比为 1 倍和 3 倍时，有 53%和 81%的概率是有效的。
结论
与 leuprorelin 相比，degarelix 治疗前列腺癌具有成本效益。此外，方案、单向和概率敏感性分析表明该模型具有稳健性。
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