College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Guangzhou ZhongWei Public Health Technology Accessment Institute, Guangzhou, China.
PLoS One. 2024 Mar 4;19(3):e0295090. doi: 10.1371/journal.pone.0295090. eCollection 2024.
To evaluate the cost-effectiveness of Tislelizumab vs Sorafenib as the first-line treatment of unresectable hepatocellular carcinoma (HCC) from the perspective of the Chinese health service system.
A lifetime partitioned survival model (PSM) was developed to cost-effectively analyze Tislelizumab vs Sorafenib as the first-line treatment of unresectable HCC. The clinical and safety data were derived from a recently randomized clinical trial (RATIONALE-301). Utilities were collected from the published literature. Costs were obtained from an open-access database (http://www.yaozh.com) and previous studies. The model cycle was 21 days, according to the RATIONALE-301 study, and the simulation period was patients' lifetime. Long-term direct medical costs and quality-adjusted life-years (QALYs) were determined. The incremental cost-effectiveness ratio (ICER) was used as the evaluation index. one-way sensitivity analysis (OSWA) and probabilistic sensitivity analysis (PSA) were used to analyze the uncertainty of parameters and to adjust and verify the stability of the baseline results.
The Tislelizumab group generated a cost of $39,746.34 and brought health benefits to 2.146 QALYs, while the cost and utility of the Sorafenib group were $26750.95 and 1.578 QALYs, respectively. The Tislelizumab group increased QALYs by 0.568, the incremental cost was $12995.39, and the ICER was $22869.64/QALY, lower than the willingness to pay threshold (WTP). OSWA results showed that the utility of progressed disease (PD), cost of Camrelizumab, and cost of Tislelizumab were the main factors affecting the ICER. PSA results showed that, within 1000 times the Monte Carlo simulation, the cost of the Tislelizumab group was lower than three times the per capita gross domestic product (GDP) of China ($37653/QALY). The cost-effectiveness acceptability curves (CEAC) revealed that when WTP was no less than $12251.00, the Tislelizumab group was the dominant scheme, and the economic advantage grew with an increasing WTP. When WTP ≥ $19000.00, the Tislelizumab group became the absolute economic advantage.
Under the current economic conditions in China, the Tislelizumab therapeutic scheme is more cost-effective than the Sorafenib therapeutic scheme for treating patients with unresectable HCC.
从中国卫生服务体系的角度评估替雷利珠单抗对比索拉非尼作为不可切除肝细胞癌（HCC）一线治疗的成本效益。
采用基于生存的终生分区模型（PSM）对替雷利珠单抗对比索拉非尼作为不可切除 HCC 一线治疗的成本效益进行分析。临床和安全性数据来自最近的一项随机临床试验（RATIONALE-301）。效用值取自已发表文献。成本取自公开数据库（http://www.yaozh.com）和既往研究。模型周期为 21 天，模拟患者终生。确定了增量成本效益比（ICER）作为评价指标。采用单因素敏感性分析（OSWA）和概率敏感性分析（PSA）分析参数的不确定性，并调整和验证基线结果的稳定性。
替雷利珠单抗组的成本为 39746.34 美元，带来了 2.146 个质量调整生命年（QALYs）的健康效益，而索拉非尼组的成本和效用分别为 26750.95 美元和 1.578 QALYs。替雷利珠单抗组增加了 0.568 个 QALY，增量成本为 12995.39 美元，ICER 为 22869.64 美元/QALY，低于意愿支付阈值（WTP）。OSWA 结果表明，疾病进展（PD）效用、卡瑞利珠单抗成本和替雷利珠单抗成本是影响 ICER 的主要因素。PSA 结果表明，在 1000 次蒙特卡罗模拟中，替雷利珠单抗组的成本低于中国人均国内生产总值（GDP）的三倍（37653 美元/QALY）。成本效益接受曲线（CEAC）显示，当 WTP 不低于 12251.00 美元时，替雷利珠单抗组是主导方案，随着 WTP 的增加，其经济性优势也在不断扩大。当 WTP≥19000.00 美元时，替雷利珠单抗组成为绝对经济优势方案。
在中国当前经济条件下，替雷利珠单抗治疗方案在治疗不可切除 HCC 患者方面比索拉非尼治疗方案更具成本效益。
