Zhu Youwen, Liu Kun, Zhu Hong, Wu Haijun
Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Therap Adv Gastroenterol. 2023 Nov 2;16:17562848231207200. doi: 10.1177/17562848231207200. eCollection 2023.
Nivolumab plus chemotherapy (NC) was recently approved as the first-line intervention for human epidermal growth factor receptor 2-negative advanced gastric/gastroesophageal junction cancer (GC/GEJC). Moreover, in the latest KEYNOTE-859 (NCT03675737), pembrolizumab plus chemotherapy (PC) was demonstrated to produce remarkable patient survival outcomes.
The clinicians and patients need to assess NC and PC preference for cancer drugs.
The cost-effective analysis.
In an economic assessment of the United States, United Kingdom, and Chinese healthcare systems using a Markov model simulated patients with GC/GEJC, two treatment decision branches with three health states and a tracked time horizon of 15 years were developed. The overall cost and efficacy outcomes of first-line strategies PC and NC were evaluated at willingness-to-pay (WTP) thresholds of different national, including life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and incremental net-health benefit (INHB). Sensitivity and subgroup analyses were considered.
Given a WTP threshold of $150,000, $60,161, and $37,653 per QALY in the United States, United Kingdom, and China, respectively, both PC and NC achieved QALYs of 1.67 and 1.65 (2.51 and 2.48 LYs), 1.65 and 1.63 (2.48 and 2.45 LYs), and 1.60 and 1.58 (2.40 and 2.37 LYs), with total costs of $242,444 and $232,617, $148,367 and $127,737, and $16,693 and $24,016, respectively. Based on our sensitivity analysis, the programmed death-1 inhibitors cost produced the largest impact on the outcome. In addition, the cost-effectiveness probabilities of PC were 38.3%, 4.1%, and 100% in the three aforementioned countries, respectively.
In the case of the Chinese payers' perspective, PC appeared more dominant as first-line therapy for advanced GC/GEJC patients, whereas NC was preferred in the United States and United Kingdom.
纳武利尤单抗联合化疗（NC）最近被批准作为人表皮生长因子受体2阴性晚期胃癌/胃食管交界癌（GC/GEJC）的一线干预措施。此外，在最新的KEYNOTE-859（NCT03675737）研究中，帕博利珠单抗联合化疗（PC）被证明能产生显著的患者生存结果。
临床医生和患者需要评估癌症药物对NC和PC的偏好。
成本效益分析。
在美国、英国和中国医疗保健系统的经济评估中，使用马尔可夫模型模拟GC/GEJC患者，构建了两个具有三种健康状态的治疗决策分支，并设定了15年的跟踪时间范围。在不同国家的支付意愿（WTP）阈值下，评估一线策略PC和NC的总体成本和疗效结果，包括生命年（LYs）、质量调整生命年（QALYs）、增量成本效益比（ICERs）和增量净健康效益（INHB）。同时进行了敏感性分析和亚组分析。
在美国、英国和中国，每QALY的WTP阈值分别为150,000美元、60,161美元和37,653美元的情况下，PC和NC的QALY分别为1.67和1.65（2.51和2.48 LYs）、1.65和1.63（2.48和2.45 LYs）以及1.60和1.58（2.40和2.37 LYs），总成本分别为242,444美元和232,617美元、148,367美元和127,737美元以及16,693美元和24,016美元。基于我们的敏感性分析，程序性死亡-1抑制剂成本对结果的影响最大。此外，PC在上述三个国家的成本效益概率分别为38.3%、4.1%和100%。
从中国支付方的角度来看，PC作为晚期GC/GEJC患者的一线治疗似乎更具优势，而在美国和英国则更倾向于NC。
