多塔利单抗联合卡铂-紫杉醇作为晚期子宫内膜癌一线治疗的成本效果分析。
Cost-effectiveness analysis of dostarlimab plus carboplatin-paclitaxel as first-line treatment for advanced endometrial cancer.
机构信息
Department of Pharmacy, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China.
Department of Pharmacy, The Second Hospital of Zhangzhou, Zhangzhou, Fujian, China.
出版信息
Front Immunol. 2023 Sep 4;14:1267322. doi: 10.3389/fimmu.2023.1267322. eCollection 2023.
BACKGROUND
A recent phase III clinical trial (NCT03981796) evaluated the efficacy and safety of dostarlimab combined with carboplatin-paclitaxel (DOS-CP) compared to placebo combined with carboplatin-paclitaxel (PLB-CP) as a first-line treatment for advanced endometrial cancer (EC). The NCT03981796 trial demonstrated that DOS-CP significantly improved progression-free survival and overall survival of patients with advanced EC while maintaining an acceptable safety profile. However, DOS-CP is expensive and its cost-effectiveness has not been evaluated. This study aims to evaluate the cost-effectiveness of DOS-CP compared to PLB-CP as a first-line treatment for advanced EC from the perspective of the Chinese healthcare system.
METHODS
A Markov model with three health states was developed to evaluate the cost-effectiveness of DOS-CP as a first-line treatment for advanced EC. Clinical efficacy data were derived from the NCT03981796 trial, and drug costs were determined based on national tender prices. Other costs and utility values were obtained from published literature. The outcomes assessed included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The robustness of the model was assessed through one-way sensitivity analysis and probabilistic sensitivity analysis.
RESULTS
In comparison to PLB-CP, the ICER of DOS-CP was $98,276.61/QALY for the overall population, $53,063.61/QALY for the dMMR subgroup, and $124,088.56/QALY for the pMMR subgroup. All of these ICER values were higher than the willingness-to-pay threshold of $38,201 per QALY. The most important variable that affected the results of the model was the discount rate, the cost of dostarlimab, and the utility value for progressive disease.
CONCLUSION
From the perspective of the Chinese healthcare system, DOS-CP is unlikely to be a cost-effective first-line treatment option for advanced EC.
背景
一项最近的 III 期临床试验（NCT03981796）评估了 dostarlimab 联合卡铂紫杉醇（DOS-CP）与安慰剂联合卡铂紫杉醇（PLB-CP）作为晚期子宫内膜癌（EC）一线治疗的疗效和安全性。NCT03981796 试验表明，DOS-CP 显著改善了晚期 EC 患者的无进展生存期和总生存期，同时保持了可接受的安全性。然而，DOS-CP 价格昂贵，其成本效益尚未得到评估。本研究旨在从中国医疗保健系统的角度评估 DOS-CP 与 PLB-CP 相比作为晚期 EC 一线治疗的成本效益。
方法
建立了一个具有三个健康状态的 Markov 模型，以评估 DOS-CP 作为晚期 EC 一线治疗的成本效益。临床疗效数据来自 NCT03981796 试验，药物成本根据国家招标价格确定。其他成本和效用值来自已发表的文献。评估的结果包括总费用、质量调整生命年（QALYs）和增量成本效益比（ICERs）。通过单因素敏感性分析和概率敏感性分析评估模型的稳健性。
结果
与 PLB-CP 相比，DOS-CP 的总体人群 ICER 为 98276.61 美元/QALY，dMMR 亚组为 53063.61 美元/QALY，pMMR 亚组为 124088.56 美元/QALY。所有这些 ICER 值均高于 38201 美元/QALY 的意愿支付阈值。影响模型结果的最重要变量是贴现率、dostarlimab 的成本和进展性疾病的效用值。
结论
从中国医疗保健系统的角度来看，DOS-CP 不太可能成为晚期 EC 的一种具有成本效益的一线治疗选择。
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