School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Gynecol Oncol. 2023 Jul;174:175-181. doi: 10.1016/j.ygyno.2023.05.010. Epub 2023 May 18.
This study aimed to evaluate the cost-effectiveness of niraparib versus routine surveillance as maintenance therapy for patients with platinum-sensitive recurrent ovarian cancer in China.
A three-state partitioned survival model that adopted a lifetime horizon with a 4-week cycle length was developed. Efficacy data were derived from the NORA study. Cost and utility data were obtained from published studies and online databases. The cost and health outcomes were discounted at an annual rate of 5%. In this analysis, the primary outcomes included quality-adjusted life-year (QALY) and incremental cost-effectiveness ratio (ICER). The willingness-to-pay (WTP) thresholds were set at 1 to 3 times the gross domestic product per capita of China in 2022 ($12,741 to $38,233/QALY). Sensitivity analyses were conducted to verify the robustness of the model results.
In the base-case analysis, niraparib was not found to be cost-effective, with an ICER of $42,888/QALY compared with routine surveillance at the WTP thresholds. One-way deterministic sensitivity analyses indicated that the ICER value was most sensitive to the cost of subsequent treatment in placebo group. The probabilistic sensitivity analysis suggested that at the WTP thresholds, the probability of niraparib being cost-effective was 2.9% to 50.1%.
Niraparib improves the survival benefit of platinum-sensitive recurrent ovarian cancer patients. However, it seems to be less cost-effective, as it has higher costs than routine surveillance at the WTP thresholds. Reasonable dose reduction according to the patient's actual situation or lowering the price of niraparib can improve its cost-effectiveness.
本研究旨在评估尼拉帕利对比常规监测作为中国铂敏感复发性卵巢癌患者维持治疗的成本效果。
采用具有 4 周治疗周期的终生时间区间的三状态分区生存模型。疗效数据来源于 NORA 研究。成本和效用数据来自已发表的研究和在线数据库。成本和健康结果以 5%的年率贴现。在该分析中，主要结局包括质量调整生命年（QALY）和增量成本效果比（ICER）。意愿支付（WTP）阈值设定为中国 2022 年人均国内生产总值的 1 至 3 倍（12741 美元至 38233 美元/QALY）。进行了敏感性分析以验证模型结果的稳健性。
在基础分析中，与常规监测相比，尼拉帕利在 WTP 阈值下的 ICER 为 42888 美元/QALY，不具有成本效果。单因素确定性敏感性分析表明，ICER 值对安慰剂组后续治疗的成本最为敏感。概率敏感性分析表明，在 WTP 阈值下，尼拉帕利具有成本效果的概率为 2.9%至 50.1%。
尼拉帕利改善了铂敏感复发性卵巢癌患者的生存获益。然而，与常规监测相比，它的成本效果似乎较差，因为它的成本高于 WTP 阈值。根据患者的实际情况合理减少剂量或降低尼拉帕利的价格可以提高其成本效果。
