Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Front Public Health. 2023 Jan 30;11:1009920. doi: 10.3389/fpubh.2023.1009920. eCollection 2023.
BACKGROUND AND OBJECTIVE: Tislelizumab is a programmed cell death protein-1 (PD-1) inhibitor. Tislelizumab plus chemotherapy as first-line option for advanced non-squamous non-small cell lung cancer (NSCLC), compared with chemotherapy alone, resulted in significantly prolonged survival outcomes; however, evidence regarding its relative efficacy and cost is lacking. We aimed to evaluate the cost-effectiveness of tislelizumab plus chemotherapy compared with that of chemotherapy alone, from the health care perspective in China. METHODS: A partitioned survival model (PSM) was used for this study. The survival data were obtained from the RATIONALE 304 trial. Cost-effectiveness was defined as incremental cost-effectiveness ratio (ICER) less than the willingness to pay (WTP) threshold. Incremental net health benefits (INHB), incremental net monetary benefits (INMB), and subgroup analyses were also assessed. Sensitivity analyses were further established to assess the model stability. RESULTS: Compared with chemotherapy alone, tislelizumab plus chemotherapy increased by 0.64 quality-adjusted life-years (QALYs) and 1.48 life-years, and yielded an increase of $16,631 in cost per patient. The INMB and INHB were $7,510 and 0.20 QALYs at a WTP threshold of $38,017/QALY, respectively. The ICER was $26,162/QALY. The outcomes were most sensitive to the HR of OS for tislelizumab plus chemotherapy arm. The probability of tislelizumab plus chemotherapy being considered cost-effective was 87.66% and >50% in most of the subgroups at the WTP threshold of $38,017/QALY. At the WTP threshold of $86,376/QALY, the probability achieved 99.81%. Furthermore, the probability of tislelizumab plus chemotherapy being considered cost-effective in subgroups of patients with liver metastases and PD-L1 expression ≥50% were 90.61 and 94.35%, respectively. CONCLUSION: Tislelizumab plus chemotherapy is likely to be cost-effective as a first-line treatment for advanced non-squamous NSCLC in China.
背景与目的：替雷利珠单抗是一种程序性死亡蛋白-1（PD-1）抑制剂。替雷利珠单抗联合化疗作为晚期非鳞状非小细胞肺癌（NSCLC）的一线治疗选择，与单独化疗相比，显著延长了生存结局；然而，缺乏其相对疗效和成本的证据。我们旨在从中国卫生保健角度评估替雷利珠单抗联合化疗与单独化疗相比的成本效益。 方法：本研究采用分区生存模型（PSM）。生存数据来自 RATIONALE 304 试验。成本效益定义为增量成本效益比（ICER）低于意愿支付（WTP）阈值。还评估了增量净健康效益（INHB）、增量净货币效益（INMB）和亚组分析。进一步建立敏感性分析以评估模型稳定性。 结果：与单独化疗相比，替雷利珠单抗联合化疗增加了 0.64 个质量调整生命年（QALYs）和 1.48 个生命年，每个患者的成本增加了 16631 美元。在 WTP 阈值为 38017 美元/QALY 时，INMB 和 INHB 分别为 7510 美元和 0.20 QALY。ICER 为 26162 美元/QALY。结果对 OS 的替雷利珠单抗联合化疗组 HR 最敏感。在 WTP 阈值为 38017 美元/QALY 时，替雷利珠单抗联合化疗在大多数亚组中的成本效益概率为 87.66%，在 50%以上。在 WTP 阈值为 86376 美元/QALY 时，概率达到 99.81%。此外，在肝转移和 PD-L1 表达≥50%的患者亚组中，替雷利珠单抗联合化疗被认为具有成本效益的概率分别为 90.61%和 94.35%。 结论：替雷利珠单抗联合化疗可能是中国晚期非鳞状 NSCLC 的一种具有成本效益的一线治疗选择。
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