EMD Serono, Rockland, MA, USA.
the healthcare business of Merck KGaA, Darmstadt, Germany.
Value Health. 2023 Apr;26(4):487-497. doi: 10.1016/j.jval.2022.11.018. Epub 2022 Dec 8.
From the US Medicare perspective, this study compared the cost-effectiveness of tepotinib and capmatinib for treating metastatic non-small cell lung cancer with tumors harboring mesenchymal-epithelial transition factor gene exon 14 skipping.
A 3-state partitioned survival model assessed outcomes over a lifetime horizon. Parametric survival analysis of the phase 2 VISION trial informed clinical inputs for tepotinib. Capmatinib inputs were captured using hazard ratios derived from an unanchored matching-adjusted indirect comparison study and published literature. National cost databases, trial data, and literature furnished drug, treatment monitoring, and disease/adverse event management expenditures (2021 US dollars) and utility inputs. Outcomes were discounted at 3% annually.
In the base case, tepotinib dominated capmatinib in frontline settings (incremental discounted quality-adjusted life-years [QALYs] and costs of 0.2127 and -$47 756, respectively) while realizing an incremental cost-effectiveness ratio of $274 514/QALY in subsequent lines (incremental QALYs and costs of 0.3330 and $91 401, respectively). In a line agnostic context, tepotinib produced an incremental cost-effectiveness ratio of $105 383/QALY (incremental QALYs and costs of 0.2794 and $29 447, respectively). Sensitivity and scenarios analyses for individual lines typically supported the base case, whereas those for the line agnostic setting suggested sensitivity to drug acquisition costs and efficacy inputs.
Tepotinib could be cost-effective versus capmatinib in frontline and line agnostic contexts, considering the range of willingness-to-pay thresholds recommended by the Institute for Clinical and Economic Review ($100 000-$150 000/QALY). Tepotinib could be cost-effective in subsequent lines at higher willingness-to-pay levels. These results are to be interpreted cautiously, considering uncertainty in key model inputs.
从美国医疗保险的角度出发，本研究比较了 tepotinib 和 capmatinib 治疗携带间质上皮转化因子基因外显子 14 跳跃的转移性非小细胞肺癌的成本效益。
一个 3 状态分区生存模型评估了终身范围内的结果。对 2 期 VISION 试验的参数生存分析为 tepotinib 提供了临床输入。Capmatinib 的输入是通过无锚定匹配调整间接比较研究和已发表文献中得出的风险比来捕获的。国家成本数据库、试验数据和文献提供了药物、治疗监测和疾病/不良事件管理支出（2021 年美元）和效用输入。结果按每年 3%贴现。
在基线情况下，在一线治疗中，tepotinib 优于 capmatinib（增量折扣后的质量调整生命年[QALYs]和成本分别为 0.2127 和-47756 美元），同时在后线治疗中实现了增量成本效益比为 274514 美元/QALY（增量 QALYs 和成本分别为 0.3330 和 91401 美元）。在不考虑治疗线的情况下，tepotinib 产生了增量成本效益比为 105383 美元/QALY（增量 QALYs 和成本分别为 0.2794 和 29447 美元）。单一线治疗的敏感性和情景分析通常支持基线情况，而不考虑治疗线的情况下的敏感性分析则表明对药物获得成本和疗效输入的敏感性。
考虑到临床和经济审查研究所推荐的支付意愿阈值范围（100000 美元至 150000 美元/QALY），tepotinib 在一线和不考虑治疗线的情况下可能比 capmatinib 更具成本效益。在更高的支付意愿水平下，tepotinib 可能在后线治疗中具有成本效益。考虑到关键模型输入的不确定性，这些结果需要谨慎解释。
