Tseng Chien-Yu, Tsai Yi-Wen, Shiu Ming-Neng
Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Front Oncol. 2023 Nov 8;13:1264417. doi: 10.3389/fonc.2023.1264417. eCollection 2023.
We aimed to evaluate the cost-effectiveness of atezolizumab plus bevacizumab (atezo-bev) versus sorafenib treatment in Taiwan.
Using sorafenib as the comparator, we developed a partitioned survival model to evaluate the costs and quality-adjusted life year (QALY) of the atezo-bev treatment. The time horizon of the study was 15 years, and the annual discount rate was 3%. We analyzed the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB) from the treatment effects (determined from the progression-free and overall survival outcomes of the IMbrave150 study), direct medical costs (collected and estimated from the National Health Insurance Research Database, Taiwan), and utility parameters (referred to the NICE technology appraisal guidance), as well as the deterministic sensitivity and probabilistic sensitivity.
Compared with sorafenib, the incremental effectiveness of atezo-bev treatment was 1.7 QALY, with an incremental cost of USD 127,607. The ICER was USD 75,192 per QALY, which was less than the predefined willingness to pay in Taiwan.
The combined treatment of atezo-bev is cost-effective when compared with sorafenib, which is currently the first-line treatment option for unresectable HCC in Taiwan.
我们旨在评估在台湾阿替利珠单抗联合贝伐珠单抗（阿替利珠单抗 - 贝伐珠单抗）对比索拉非尼治疗的成本效益。
以索拉非尼作为对照，我们建立了一个分区生存模型来评估阿替利珠单抗 - 贝伐珠单抗治疗的成本和质量调整生命年（QALY）。研究的时间范围为15年，年贴现率为3%。我们分析了增量成本效益比（ICER）和增量净货币效益（INMB），这些数据来自治疗效果（根据IMbrave150研究的无进展生存期和总生存期结果确定）、直接医疗成本（从台湾国民健康保险研究数据库收集和估算）、效用参数（参考英国国家卫生与临床优化研究所技术评估指南），以及确定性敏感性分析和概率性敏感性分析。
与索拉非尼相比，阿替利珠单抗 - 贝伐珠单抗治疗的增量效益为1.7个QALY，增量成本为127,607美元。ICER为每QALY 75,192美元，低于台湾预先定义的支付意愿。
与索拉非尼相比，阿替利珠单抗 - 贝伐珠单抗联合治疗具有成本效益，索拉非尼目前是台湾不可切除肝细胞癌（HCC）的一线治疗选择。
