Zeng Ni, Han Jiaqi, Liu Zijian, He Jinlan, Tian Kun, Chen Nianyong
Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China.
Cancers (Basel). 2023 Jun 28;15(13):3386. doi: 10.3390/cancers15133386.
(1) Background: This study aimed to conduct a NMA and CEA combined study to compare the effectiveness and cost-effectiveness of different CDK4/6 inhibitors (Abem, Palbo, and Ribo) plus NSAI with placebo plus NSAI in the first-line treatment of postmenopausal women with HR+/HER2- ABC from the perspective of payers in China. (2) Methods: Studies which evaluated CDK4/6 inhibitors plus NSAI for HR+/HER2- ABC were searched. A Bayesian NMA was carried out and the main outcomes were the hazard ratios (HRs) of overall survival (OS) and progression-free survival (PFS). The costs and efficacy of first-line therapies for HR+/HER2- ABC were evaluated using the Markov model. The main outcomes in the CEA were incremental cost-utility ratios (ICURs), incremental monetary benefit (INMB), and incremental net-health benefit (INHB). The robustness of the model was assessed by one-way, three-way, and probabilistic sensitivity analyses. Then, we further simulated the impact of different prices of CDK4/6 inhibitors on the results. (3) Results: Seven studies involving 5347 patients were included in the NMA. The three first-line CDK4/6 inhibitors plus NSAI groups provided significant PFS and OS superiority to NSAI alone. Abem + NSAI represented a significant statistical advantage onPFS (HR 0.74, 95% CI 0.61-0.90, = 0.009) and indicated a trend of being the best OS benefit compared to the placebo + NSAI group (HR 0.89, 95% CI 0.72-1.08). The Abem + NSAI, Palbo + NSAI, and Ribo + NSAI groups resulted in additional costs of $12,602, $20,391, and $81,258, with additional effects of 0.38, 0.31, and 0.30 QALYs, respectively, leading to an ICUR of $33,163/QALY, $65,777/QALY, and $270,860/QALY. Additional pairwise comparisons showed that Abem + NSAI was the only cost-effective option in three CDK4/6 inhibitors plus NSAI groups at a willingness-to-pay (WTP) of $38,029/QALY. The sensitivity analyses showed that the proportion of receiving subsequent CDK4/6 inhibitors and the cost of Abem significantly influenced the results of Abem + NSAI compared with placebo + NSAI. (4) Conclusion: From the perspective of Chinese payers, Abem + NSAI was a cost-effective treatment option compared with placebo + NSAI at the WTP of $38,029/QALY, since only the ICUR of $33,163/QALY of Abem + NSAI was lower than the WTP of $38,029/QALY in China (2022). The Palbo + NSAI and Ribo + NSAI groups were not cost-effective unless drug prices were adjusted to 50% or 10% of current prices ($320.67 per cycle or $264.60 per cycle). (5) Others: We have prospectively registered the study with the PROSPERO, and the PROSPERO registration number is CRD42023399342.
(1) 背景：本研究旨在进行一项网络Meta分析（NMA）与成本效果分析（CEA）相结合的研究，从中国支付方的角度比较不同的细胞周期蛋白依赖性激酶4/6抑制剂（阿贝西利、哌柏西利和瑞博西尼）联合非甾体抗炎药（NSAI）与安慰剂联合NSAI在一线治疗激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2-）晚期乳腺癌绝经后女性中的有效性和成本效果。(2) 方法：检索评估CDK4/6抑制剂联合NSAI用于HR+/HER2-晚期乳腺癌的研究。进行贝叶斯网络Meta分析，主要结局为总生存期（OS）和无进展生存期（PFS）的风险比（HR）。使用马尔可夫模型评估HR+/HER2-晚期乳腺癌一线治疗的成本和疗效。成本效果分析的主要结局为增量成本效用比（ICUR）、增量货币效益（INMB）和增量净健康效益（INHB）。通过单因素、三因素和概率敏感性分析评估模型的稳健性。然后，我们进一步模拟了CDK4/6抑制剂不同价格对结果的影响。(3) 结果：网络Meta分析纳入了7项研究，共5347例患者。三种一线CDK4/6抑制剂联合NSAI组在PFS和OS方面均显著优于单独使用NSAI组。阿贝西利联合NSAI在PFS方面具有显著的统计学优势（HR 0.74，95%可信区间0.61 - 0.90，P = 0.009），与安慰剂联合NSAI组相比，在OS获益方面显示出最佳趋势（HR 0.89，95%可信区间0.72 - 1.08）。阿贝西利联合NSAI组、哌柏西利联合NSAI组和瑞博西尼联合NSAI组分别导致额外成本12,602美元、20,391美元和8,1258美元，额外效果分别为0.38、0.31和0.30个质量调整生命年（QALY），导致ICUR分别为33,163美元/QALY、65,777美元/QALY和270,860美元/QALY。额外的两两比较显示，在支付意愿（WTP）为38,029美元/QALY时，阿贝西利联合NSAI是三种CDK4/6抑制剂联合NSAI组中唯一具有成本效果的选择。敏感性分析表明，接受后续CDK4/6抑制剂的比例和阿贝西利的成本与安慰剂联合NSAI组相比，对阿贝西利联合NSAI的结果有显著影响。(4) 结论：从中国支付方的角度来看，在支付意愿为38,029美元/QALY时，与安慰剂联合NSAI相比，阿贝西利联合NSAI是一种具有成本效果的治疗选择，因为在中国（2022年），只有阿贝西利联合NSAI的ICUR为33,163美元/QALY低于支付意愿38,029美元/QALY。哌柏西利联合NSAI组和瑞博西尼联合NSAI组不具有成本效果，除非药物价格调整为当前价格的50%或10%（每周期320.67美元或每周期264.60美元）。(5) 其他：我们已在国际前瞻性系统评价注册库（PROSPERO）上对该研究进行了前瞻性注册，PROSPERO注册号为CRD42023399342。
