Yang Liu, Cao Xueqiong, Li Na, Zheng Bin, Liu Maobai, Cai Hongfu
Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Pharmacy, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road 29, Fuzhou 350100, China.
Ther Adv Med Oncol. 2022 Aug 3;14:17588359221116604. doi: 10.1177/17588359221116604. eCollection 2022.
This study evaluated the cost-effectiveness of nivolumab plus ipilimumab (NI) pemetrexed plus cisplatin/carboplatin (C) as the first-line treatment for unresectable malignant pleural mesothelioma (MPM) from the perspective of US payers.
A 10-year partitioned survival model was constructed using survival and safety data from the CheckMate 743 clinical trial. The output metrics of the model included the patient's lifetime quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). Only direct medical costs were considered. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results.
Among all randomized patients, group NI had an ICER of $475,677/QALY relative to group C. Among patients with epithelioid histology, group NI had an ICER of $760,955/QALY. Among patients with non-epithelioid histology, group NI had an ICER of $418,348/QALY. The ICERs of all three populations exceeded the willingness-to-pay threshold ($150,000). The results of one-way sensitivity analysis revealed that the cost of nivolumab had a great influence on the results. The results of probabilistic sensitivity analysis demonstrated that the possibility of NI being more economical in all randomized patients and in patients with non-epidemiology histology was 0. In patients with epithelioid histology, the probability that NI had an economic advantage was 0.6%.
From the perspective of US payers, in patients with unresectable MPM, NI has no economic advantage over C.
本研究从美国医保支付方的角度评估了纳武利尤单抗联合伊匹木单抗（NI）与培美曲塞联合顺铂/卡铂（C）作为不可切除恶性胸膜间皮瘤（MPM）一线治疗方案的成本效益。
利用CheckMate 743临床试验的生存和安全性数据构建了一个10年的分段生存模型。该模型的输出指标包括患者的终身质量调整生命年（QALY）、终身成本和增量成本效益比（ICER）。仅考虑直接医疗成本。进行了单向和概率敏感性分析以评估结果的稳健性。
在所有随机分组的患者中，相对于C组，NI组的ICER为475,677美元/QALY。在组织学类型为上皮样的患者中，NI组的ICER为760,955美元/QALY。在组织学类型为非上皮样的患者中，NI组的ICER为418,348美元/QALY。所有这三类人群的ICER均超过了支付意愿阈值（150,000美元）。单向敏感性分析结果显示，纳武利尤单抗的成本对结果有很大影响。概率敏感性分析结果表明，NI在所有随机分组患者和非上皮样组织学类型患者中更具经济性的可能性为0。在上皮样组织学类型的患者中，NI具有经济优势的概率为0.6%。
从美国医保支付方的角度来看，在不可切除的MPM患者中，NI相对于C没有经济优势。
