Liang Xueyan, Chen Xiaoyu, Li Huijuan, Li Yan
Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Front Oncol. 2023 Apr 26;13:1113374. doi: 10.3389/fonc.2023.1113374. eCollection 2023.
In patients with advanced non-small cell lung cancer (aNSCLC), cemiplimab plus chemotherapy prolonged overall survival (OS) and progression-free survival (PFS) significantly compared to chemotherapy alone. The cost-effectiveness of these drugs is still uncertain. The aim of this study is to assess the cost-effectiveness of cemiplimab plus chemotherapy compared with chemotherapy for the treatment of aNSCLC from the third-party payer perspective in the United States.
The cost-effectiveness of cemiplimab with chemotherapy versus chemotherapy for the treatment of aNSCLC was evaluated using a partitioned survival model containing three mutually incompatible health states. The clinical characteristics and outcomes used in the model were gathered from EMPOWER-Lung 3 trial. We have conducted deterministic one-way sensitivity analysis and probabilistic sensitivity analysis in order to evaluate the robustness of the model. The primary outcomes considered were the costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB), and incremental net monetary benefits (INMB).
Treatment of aNSCLC with cemiplimab plus chemotherapy increased efficacy by 0.237 QALYs and was associated with an increased total cost of $50,796 compared to chemotherapy alone, resulting in an ICER of $214,256/QALY gained. At a WTP threshold of $150,000/QALY, the INHB of cemiplimab plus chemotherapy was 0.203 QALYs and the INMB was $304,704 compared to chemotherapy alone. The probabilistic sensitivity analysis revealed that there was only a 0.04% chance that cemiplimab with chemotherapy would be cost-effective at a WTP threshold of $150,000/QALY. The performance of model was mainly determined by the price of cemiplimab, according to a one-way sensitivity analysis.
From the third-party payer perspective, cemiplimab combined chemotherapy is unlikely to be a cost-effective option for the treatment of aNSCLC at the WTP threshold of $150,000/QALY in the United States.
在晚期非小细胞肺癌（aNSCLC）患者中，与单纯化疗相比，西米普利单抗联合化疗显著延长了总生存期（OS）和无进展生存期（PFS）。这些药物的成本效益仍不确定。本研究的目的是从美国第三方支付方的角度评估西米普利单抗联合化疗与单纯化疗治疗aNSCLC的成本效益。
使用包含三种相互排斥健康状态的分区生存模型评估西米普利单抗联合化疗与单纯化疗治疗aNSCLC的成本效益。模型中使用的临床特征和结果来自EMPOWER-Lung 3试验。我们进行了确定性单向敏感性分析和概率敏感性分析，以评估模型的稳健性。主要结局指标包括成本、生命年、质量调整生命年（QALY）、增量成本效益比（ICER）、增量净健康效益（INHB）和增量净货币效益（INMB）。
与单纯化疗相比，西米普利单抗联合化疗治疗aNSCLC可使疗效提高0.237个QALY，且总费用增加50,796美元，导致获得每个QALY的ICER为214,256美元。在支付意愿阈值为150,000美元/QALY时，与单纯化疗相比，西米普利单抗联合化疗的INHB为0.203个QALY，INMB为304,704美元。概率敏感性分析显示，在支付意愿阈值为150,000美元/QALY时，西米普利单抗联合化疗具有成本效益的概率仅为0.04%。根据单向敏感性分析，模型的性能主要由西米普利单抗的价格决定。
从第三方支付方的角度来看，在美国支付意愿阈值为150,000美元/QALY时，西米普利单抗联合化疗不太可能是治疗aNSCLC的具有成本效益的选择。
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