Chen Xi, Zhao Mingye, Tian Lei
Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China.
Front Pharmacol. 2023 Mar 20;14:1119906. doi: 10.3389/fphar.2023.1119906. eCollection 2023.
Non-small cell lung cancer (NSCLC) is one of the most malignant cancer types that causes substantial economic burden in China. This study aimed to evaluate the cost-effectiveness of five first-line anti-PD-(L)1 treatments, including sintilimab, camrelizumab, atezolizumab, pembrolizumab and sugemalimab with each combined with chemotherapy, for treating advanced non-squamous NSCLC (nsq-NSCLC) from Chinese healthcare system perspective. Clinical data were obtained from the following clinical trials, namely, ORIENT-11, CameL, IMpower132, KEYNOTE-189 and GEMSTONE-302. A network meta-analysis was performed based on fractional polynomial models. We constructed a partitioned survival model with a three-week cycle length and a lifetime horizon to derive the incremental cost-effectiveness ratio (ICER). We performed one-way sensitivity analysis and probablistic sensitivity analysis to test the robustness. Additionally, two scenario analyses were undertaken to investigate the impact of Patient Assistant Program on the economic conclusion and to explore potential uncertainty associated with population representativeness of the global trial. Compared with camrelizumab + chemotherapy, sugemalimab + chemotherapy and atezolizumab + chemotherapy were dominated, and the ICERs generated from sintilimab + chemotherapy and pembrolizumab + chemotherapy were $15,280.83/QALY and $159,784.76/QALY, respectively. Deterministic sensitivity analysis showed that uncertainty around ICERs was mainly driven by HR related parameters derived from NMA and drug price. The probablistic sensitivity analysis suggested that camrelizumab treatment was cost-effective at a willingness-to-pay threshold of 1-time GDP . When the threshold was set as 3-time GDP , sintilimab strategy demonstrated the excellent cost-effective advantage. Sensitivity analysis proved the reliability of base-case results. Results from two scenario analyses indicated that the primary finding was robust. In current context of Chinese healthcare system, sintilimab + chemotherapy appeared to be cost-effective for the treatment of nsq-NSCLC compared with sugemalimab, camrelizumab, pembrolizumab as well as atezolizumab combined with chemotherapy.
非小细胞肺癌（NSCLC）是中国最具恶性的癌症类型之一，造成了巨大的经济负担。本研究旨在从中国医疗保健系统的角度评估五种一线抗程序性死亡受体（配体）1（PD-(L)1）治疗方案（包括信迪利单抗、卡瑞利珠单抗、阿替利珠单抗、帕博利珠单抗和舒格利单抗分别联合化疗）治疗晚期非鳞状NSCLC（nsq-NSCLC）的成本效益。临床数据来自以下临床试验，即ORIENT-11、CameL、IMpower132、KEYNOTE-189和GEMSTONE-302。基于分数多项式模型进行了网络荟萃分析。我们构建了一个周期长度为三周且具有终身期限的分区生存模型，以得出增量成本效益比（ICER）。我们进行了单向敏感性分析和概率敏感性分析以检验稳健性。此外，还进行了两种情景分析，以研究患者援助计划对经济结论的影响，并探讨与全球试验人群代表性相关的潜在不确定性。与卡瑞利珠单抗联合化疗相比，舒格利单抗联合化疗和阿替利珠单抗联合化疗不占优势，信迪利单抗联合化疗和帕博利珠单抗联合化疗产生的ICER分别为每质量调整生命年（QALY）15280.83美元和每QALY 159784.76美元。确定性敏感性分析表明，ICER周围的不确定性主要由来自网络荟萃分析的与风险比（HR）相关的参数和药品价格驱动。概率敏感性分析表明，在支付意愿阈值为1倍国内生产总值（GDP）时，卡瑞利珠单抗治疗具有成本效益。当阈值设定为3倍GDP时，信迪利单抗策略显示出优异的成本效益优势。敏感性分析证明了基础病例结果的可靠性。两种情景分析的结果表明主要发现是稳健的。在中国医疗保健系统的当前背景下，与舒格利单抗、卡瑞利珠单抗、帕博利珠单抗以及阿替利珠单抗联合化疗相比，信迪利单抗联合化疗治疗nsq-NSCLC似乎具有成本效益。
