Luo Xia, Zhou Zhen, Zeng Xiaohui, Liu Qiao
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 Jul 22;13:935581. doi: 10.3389/fphar.2022.935581. eCollection 2022.
To investigate the cost-effectiveness of adding Chinese-developed anti-PD-1 antibody tislelizumab to first-line pemetrexed-platinum chemotherapy in (1) a study population of patients with locally advanced or metastatic nonsquamous non-small cell lung cancer (nsqNSCLC) and without known sensitizing EGFR mutations or ALK rearrangements and (2) its subgroups from the perspective of Chinese healthcare system. Separate Markov models were constructed for the entire study population and its subgroups; 10,000 patients with locally advanced or metastatic nsqNSCLC and without driver gene mutations were simulated in the first-line tislelizumab plus pemetrexed-platinum (TPP) arm and first-line pemetrexed-platinum (PP) arm, respectively. Transition probabilities were extracted from the RATIONALE 304 trial. Public health state utilities and costs were obtained from published literature, public national databases, and local general hospitals. The main outputs were incremental cost-effectiveness ratios (ICERs). The ICERs were compared to a willingness-to-pay threshold of $35,663 per quality-adjusted life-years (QALYs) to determine the cost-effective treatment. Sensitivity analyses were employed to assess the uncertainty in the model. For the entire patient population, first-line TPP versus PP use increased the effectiveness by 0.99 QALYs and healthcare costs by $28,749, resulting in an ICER of $28,749/QALY that was lower than the prespecified WTP threshold. For patient subgroups, first-line TPP conferred the greatest survival benefit in patients with PD-L1 expression ≥50%, followed by patients with liver metastasis and those who are current or former smokers. Overall, the ICERs for the first-line TPP versus PP ranged from $27,018/QALYs to $33,074/QALYs, which were consistently below the WTP threshold. For Chinese patients with locally advanced or metastatic nsqNSCLC who had no known sensitizing EGFR mutations or ALK rearrangements, adding the Chinese-developed anti-PD-1 antibody tislelizumab to the first-line pemetrexed-platinum chemotherapy was cost-effective regardless of their baseline characteristics.
从中国医疗体系的角度，调查在（1）局部晚期或转移性非鳞状非小细胞肺癌（nsqNSCLC）且无已知敏感EGFR突变或ALK重排的患者研究人群中，以及（2）其亚组中，将中国研发的抗PD-1抗体替雷利珠单抗添加到一线培美曲塞-铂类化疗中的成本效益。针对整个研究人群及其亚组构建了单独的马尔可夫模型；分别在一线替雷利珠单抗联合培美曲塞-铂类（TPP）组和一线培美曲塞-铂类（PP）组中模拟了10,000例局部晚期或转移性nsqNSCLC且无驱动基因突变的患者。转移概率从RATIONALE 304试验中提取。公共卫生状态效用和成本从已发表的文献、国家公共数据库和当地综合医院获取。主要产出为增量成本效益比（ICER）。将ICER与每质量调整生命年（QALY）35,663美元的支付意愿阈值进行比较，以确定具有成本效益的治疗方案。采用敏感性分析来评估模型中的不确定性。对于整个患者群体，一线使用TPP与PP相比，有效性提高了0.99 QALY，医疗成本增加了28,749美元，导致ICER为28,749美元/QALY，低于预先设定的支付意愿阈值。对于患者亚组，一线TPP在PD-L1表达≥50%的患者中带来最大的生存获益，其次是肝转移患者以及当前或既往吸烟者。总体而言，一线TPP与PP相比的ICER范围为27,018美元/QALY至33,074美元/QALY，均持续低于支付意愿阈值。对于无已知敏感EGFR突变或ALK重排的中国局部晚期或转移性nsqNSCLC患者，无论其基线特征如何，在一线培美曲塞-铂类化疗中添加中国研发的抗PD-1抗体替雷利珠单抗均具有成本效益。
