Lu Tingting, Huang Yufan, Cai Zhongjie, Lin Wangchun, Chen Xiaoxiao, Chen Ruijia, Hu Yingying
Department of Pharmacy, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China.
Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Front Pharmacol. 2023 Jul 26;14:1171302. doi: 10.3389/fphar.2023.1171302. eCollection 2023.
The EMPOWER-LUNG 3 clinical trial has shown that cemiplimab plus chemotherapy (CCT) significantly extended overall survival (OS) and progression-free survival (PFS) for patients with advanced non-small cell cancer (NSCLC) compared to placebo plus chemotherapy (PCT). However, the cost-effectiveness of this new treatment option remains unknown. Thus, we evaluated the cost-effectiveness of CCT versus (vs.) PCT as the first-line treatment for patients with advanced NSCLC from the perspective of the Chinese healthcare system. We constructed a Markov model to evaluate the cost-effectiveness of CCT as the first-line treatment for patients with advanced NSCLC. The transition probabilities were extracted from the survival data of the EMPOWER-LUNG 3 trial. The drugs' costs were referred from national tender prices, while other model input parameters were derived from the EMPOWER-LUNG 3 trial and published literature. The outcome parameters mainly included quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis and probabilistic sensitivity analysis were performed to evaluate the robustness of the model outcomes. Compared to PCT, in the CCT regimen, an additional $79,667 was spent in terms of the total cost and with an additional 0.31 QALYs, resulting in an ICER value of $253,148/QALY. Sensitivity analysis indicated that the hazard ratio (HR) of OS, the cost of cemiplimab (100 mg), and the HR of PFS, all significantly impacted the model's results. The probability of CCT (vs. PCT) being cost-effective was 0% at a willingness-to-pay threshold of $38,201/QALYs in China. The scenario analysis showed that when the price of cemiplimab was reduced to less than $184.09/100 mg, the CCT regimen could be considered cost-effective as the first-line treatment for patients with advanced NSCLC compared to the PCT. In China, the CCT was not cost-effective as the first-line treatment for patients with advanced NSCLC.
EMPOWER-LUNG 3临床试验表明，与安慰剂联合化疗（PCT）相比，西米普利单抗联合化疗（CCT）显著延长了晚期非小细胞肺癌（NSCLC）患者的总生存期（OS）和无进展生存期（PFS）。然而，这种新治疗方案的成本效益仍然未知。因此，我们从中国医疗保健系统的角度评估了CCT与PCT作为晚期NSCLC患者一线治疗的成本效益。我们构建了一个马尔可夫模型来评估CCT作为晚期NSCLC患者一线治疗的成本效益。转移概率从EMPOWER-LUNG 3试验的生存数据中提取。药物成本参考国家招标价格，而其他模型输入参数则来自EMPOWER-LUNG 3试验和已发表的文献。结果参数主要包括质量调整生命年（QALY）和增量成本效益比（ICER）。进行了单向敏感性分析和概率敏感性分析以评估模型结果的稳健性。与PCT相比，在CCT治疗方案中，总成本额外花费79,667美元，QALY增加0.31，导致ICER值为253,148美元/QALY。敏感性分析表明，OS的风险比（HR）、西米普利单抗（100 mg）的成本以及PFS的HR均对模型结果有显著影响。在中国，支付意愿阈值为38,201美元/QALY时，CCT（相对于PCT）具有成本效益的概率为0%。情景分析表明，当西米普利单抗价格降至低于184.09美元/100 mg时，与PCT相比，CCT治疗方案可被视为晚期NSCLC患者一线治疗的成本效益方案。在中国，CCT作为晚期NSCLC患者的一线治疗不具有成本效益。
