Zhu Youwen, Liu Kun, Yang Qiuping, Zeng Manting, Peng Libo
Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Pathology, Tangshan Cancer Hospital, Tangshan, Hebei, China.
Front Public Health. 2023 Mar 16;11:1028202. doi: 10.3389/fpubh.2023.1028202. eCollection 2023.
Many randomized controlled trials have indicated that immuno-chemotherapy could generate clinical benefits, though the cost of immuno-chemotherapy was so prohibitive and the options were varied. This investigation aimed at evaluating effectiveness, safety, and cost-effectiveness for immuno-chemotherapy as a first-line therapeutic option for ES-SCLC patients.
Multiple scientific literature repositories were searched for clinical studies where immuno-chemotherapy was regarded as the first-line treatment for ES-SCLC, which were published in English between Jan 1, 2000, and Nov 30, 2021. This study conducted a network meta-analysis (NMA) and cost-effectiveness analysis (CEA) based upon US-resident payer perspectives. Overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were evaluated through NMA. In addition, costings, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-benefit ratio (ICER) were estimated by CEA.
We identified 200 relevant search records, of which four randomized controlled trials (RCTs) (2,793 patients) were included. NMA demonstrated that the effect of atezolizumab plus chemotherapy was ranked at a more elevated position in comparison to other immuno-chemotherapy options and chemotherapy alone, within the general population. The influence of atezolizumab plus chemotherapy and durvalumab plus chemotherapy was ranked higher within populations experiencing non-brain metastases (NBMs) andbrain metastases (BMs), respectively. The CEA revealed that the ICERs of immuno-chemotherapy over chemotherapyalone were higher than the willingness-to-pay (WTP) threshold of $150,000/QALY in any population. However, treatment with atezolizumab plus chemotherapy and durvalumab plus chemotherapy were more favorable health advantages than other immuno-chemotherapy regimens and chemotherapy alone, and the results were 1.02 QALYs and 0.89 QALYs within overall populations and populations with BMs, respectively.
The NMA and cost-effectiveness investigation demonstrated that atezolizumab plus chemotherapy could be an optimal first-line therapeutic option for ES-SCLC when compared with other immuno-chemotherapy regimens. Durvalumab plus chemotherapy is likely to be the most favorable first-line therapeutic option for ES-SCLC with BMs.
许多随机对照试验表明，免疫化疗可带来临床益处，尽管免疫化疗的成本高昂且方案多样。本研究旨在评估免疫化疗作为广泛期小细胞肺癌（ES-SCLC）患者一线治疗方案的有效性、安全性和成本效益。
检索多个科学文献库，查找2000年1月1日至2021年11月30日期间发表的将免疫化疗作为ES-SCLC一线治疗的临床研究。本研究基于美国居民支付方的视角进行网络荟萃分析（NMA）和成本效益分析（CEA）。通过NMA评估总生存期（OS）、无进展生存期（PFS）和不良事件（AE）。此外，通过CEA估算成本、生命年（LYs）、质量调整生命年（QALYs）和增量成本效益比（ICER）。
我们识别出200条相关检索记录，其中纳入了四项随机对照试验（RCT）（共2793例患者）。NMA表明，在总体人群中，阿替利珠单抗联合化疗的效果相较于其他免疫化疗方案及单纯化疗处于更高水平。阿替利珠单抗联合化疗和度伐利尤单抗联合化疗的影响分别在非脑转移（NBMs）人群和脑转移（BMs）人群中排名更高。CEA显示，在任何人群中，免疫化疗相对于单纯化疗的ICER均高于150,000美元/QALY的支付意愿（WTP）阈值。然而，阿替利珠单抗联合化疗和度伐利尤单抗联合化疗比其他免疫化疗方案及单纯化疗具有更有利的健康效益，在总体人群和BMs人群中的结果分别为1.02 QALYs和0.89 QALYs。
NMA和成本效益研究表明，与其他免疫化疗方案相比，阿替利珠单抗联合化疗可能是ES-SCLC的最佳一线治疗方案。度伐利尤单抗联合化疗可能是伴有BMs的ES-SCLC最有利的一线治疗方案。
