Zhou Dongchu, Luo Xia, Zhou Zhen, Zeng Xiaohui, Wan Xiaomin, Tan Chongqing, 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 Aug 25;13:880280. doi: 10.3389/fphar.2022.880280. eCollection 2022.
Domestic PD-1inhibitor tislelizumab has emerged as a promising treatment for Chinese patients with driver-negative advanced or metastatic non-small cell lung cancer (NSCLC). The purpose of our study to evaluate whether tislelizumab is cost-effective as a second- or third-line treatment for this population compared with docetaxel (conventional chemotherapy) and nivolumab (imported PD-1inhibitor), from the perspective of the Chinese healthcare system. A Markov model with a 3-week Markov cycle and a 30-year time horizon was built to compare the cost-effectiveness of second- or third-line tislelizumab versus docetaxel and nivolumab. Transition probabilities, including disease progression, survival, and adverse events (AEs)-related treatment discontinuation event, were estimated from the clinical trials. Costs and health utilities were collected from local hospitals, public database and published literature. Compared with docetaxel, tislelizumab provided an additional 0.33 quality-adjusted life-years (QALYs) (1.37 vs. 1.04 QALYs) at an incremental cost of $9,286 ($23,646 vs. $14,360) for Chinese patients with driver-negative advanced or metastatic NSCLC, resulting in an incremental cost-effectiveness ratio (ICER) of $27,959/QALY under the WTP threshold of $35,663/QALY used in the model. Compared with nivolumab, tislelizumab was associated with a lower cost ($23,646 vs. $59,447) and higher QALYs (1.37 vs. 1.20 QALYs), resulting in its dominance of nivolumab. From the perspective of the Chinese healthcare system, domestic PD-1inhibitor tislelizumab immunotherapy represents a cost-effective treatment strategy compared with conventional docetaxel chemotherapy and imported PD-1inhibitor nivolumab immunotherapy in the treatment of driver-negative advanced or metastatic NSCLC beyond the first-line setting. In the era of "Universal Medical Insurance System", the rational use of domestic anticancer drugs guided by cost-benefit evidence would be an effective means to balance the limited expenditure of medical insurance fund and the growing demand for cancer treatments.
国产PD-1抑制剂替雷利珠单抗已成为治疗驱动基因阴性的晚期或转移性非小细胞肺癌（NSCLC）中国患者的一种有前景的疗法。我们研究的目的是从中国医疗保健系统的角度，评估与多西他赛（传统化疗）和纳武利尤单抗（进口PD-1抑制剂）相比，替雷利珠单抗作为该人群二线或三线治疗的成本效益。构建了一个具有3周马尔可夫周期和30年时间跨度的马尔可夫模型，以比较二线或三线替雷利珠单抗与多西他赛和纳武利尤单抗的成本效益。从临床试验中估计了包括疾病进展、生存以及与不良事件（AE）相关的治疗中断事件等转移概率。成本和健康效用值从当地医院、公共数据库及已发表的文献中收集。对于驱动基因阴性的晚期或转移性NSCLC中国患者，与多西他赛相比，替雷利珠单抗可额外提供0.33个质量调整生命年（QALY）（1.37 vs. 1.04 QALY），增量成本为9286美元（23646美元 vs. 14360美元），在模型中使用的每QALY意愿支付阈值35663美元下，增量成本效益比（ICER）为27959美元/QALY。与纳武利尤单抗相比，替雷利珠单抗成本更低（23646美元 vs. 59447美元）且QALY更高（1.37 vs. 1.20 QALY），结果显示替雷利珠单抗优于纳武利尤单抗。从中国医疗保健系统的角度来看，在一线治疗之后，国产PD-1抑制剂替雷利珠单抗免疫疗法与传统多西他赛化疗和进口PD-1抑制剂纳武利尤单抗免疫疗法相比，是一种具有成本效益的治疗策略。在“全民医保体系”时代，以成本效益证据为指导合理使用国产抗癌药物将是平衡医疗保险基金有限支出与癌症治疗不断增长需求的有效手段。
J Manag Care Spec Pharm. 2025-1
Front Public Health. 2021
Cancers (Basel). 2021-11-27
Biochim Biophys Acta Rev Cancer. 2022-1
Nat Rev Clin Oncol. 2021-10
Zotero 插件