Shi Yin, Xiao Di, Li Shuishi, Liu Shao, Zhang Yu
Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Front Pharmacol. 2023 Jul 27;14:1198585. doi: 10.3389/fphar.2023.1198585. eCollection 2023.
Niraparib improved survival in platinum-sensitive recurrent ovarian cancer (PSROC) patients routine surveillance, accompanied by increased costs. Based on the NORA trial, we evaluated for the first time the cost-effectiveness of maintenance niraparib with individualized starting dosage (ISD) in China. A Markov model was developed to simulate the costs and health outcomes of each strategy. The total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured. One-way and probabilistic sensitivity analysis were performed to estimate model robustness. Scenario analyses were also conducted. Compared to routine surveillance, niraparib additionally increased QALYs by 0.59 and 0.30 in populations with and without germline (g) mutations, with incremental costs of $10,860.79 and $12,098.54, respectively. The ICERs of niraparib over routine surveillance were $18,653.67/QALY and $39,212.99/QALY. At a willingness-to-pay (WTP) threshold of $37,488/QALY, the ISD enhanced the likelihood of cost-effectiveness from 9.35% to 30.73% in the g-mutated group and from 0.77% to 11.74% in the non-g mutated population. The probability of niraparib being cost-effective in the region with the highest Gross Domestic Product (GDP) in China was 74.23% and 76.10% in the g-mutated and non-g mutated population, respectively. Niraparib was 100% cost-effective for National Basic Medical Insurance beneficiaries under the above WTP thresholds. Compared to routine surveillance, the ISD of niraparib for maintenance treatment of PSROC is cost-effective in the g-mutated population and more effective but costly in the non-g mutated patients. The optimized niraparib price, economic status, and health insurance coverage may benefit the economic outcome.
尼拉帕利可改善铂敏感复发性卵巢癌（PSROC）患者的生存率，但需进行常规监测，且成本会增加。基于NORA试验，我们首次在中国评估了采用个体化起始剂量（ISD）的尼拉帕利维持治疗的成本效益。建立了一个马尔可夫模型来模拟每种策略的成本和健康结果。测量了总成本、质量调整生命年（QALY）和增量成本效益比（ICER）。进行了单向和概率敏感性分析以评估模型的稳健性。还进行了情景分析。与常规监测相比，在有和没有胚系（g）突变的人群中，尼拉帕利分别使QALY额外增加了0.59和0.30，增量成本分别为10,860.79美元和12,098.54美元。尼拉帕利相对于常规监测的ICER分别为18,653.67美元/QALY和39,212.99美元/QALY。在支付意愿（WTP）阈值为37,488美元/QALY时，ISD使g突变组的成本效益可能性从9.35%提高到30.73%，在非g突变人群中从0.77%提高到11.74%。在中国国内生产总值（GDP）最高的地区，尼拉帕利具有成本效益的概率在g突变人群和非g突变人群中分别为74.23%和76.10%。在上述WTP阈值下，尼拉帕利对国家基本医疗保险受益人的成本效益为100%。与常规监测相比，用于PSROC维持治疗的尼拉帕利ISD在g突变人群中具有成本效益，在非g突变患者中更有效但成本更高。优化尼拉帕利价格、经济状况和医疗保险覆盖范围可能有利于经济结果。
