Liu Kun, Zhu Youwen, Zhu Hong, Zeng Manting
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.
Cancer Med. 2024 Mar;13(5):e7070. doi: 10.1002/cam4.7070.
Tumor-treating field (TTFields) was a novel antitumor therapy that provided significant survival for previously treated metastatic non-small cell lung cancer (mNSCLC). The consistency of the cost of the new treatment regimen with its efficacy was the main objective of the study.
The primary parameters, derived from the Phase 3 LUNAR study, were collected to evaluate the cost and efficacy of TTFields plus standard-of-care (SOC) (immune checkpoint inhibitors [ICIs] and docetaxel [DTX]) or SOC in patients with mNSCLC by establishing a three-state Markov model over a 15-year time horizon. Primary outcome measures for this study included costs, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed.
The total costs of TTFields plus SOC, TTFields plus ICI, and TTFields plus DTX were $319,358, $338,688, and $298,477, generating 1.23 QALYs, 1.58 QALYs, and 0.89 QALYs, respectively. The ICERs of TTFields plus SOC versus SOC, TTFields plus ICI versus ICI, and TTFields plus DTX versus DTX were $613,379/QALY, $387,542/QALY, and $1,359,559/QALY, respectively. At willingness-to-pay (WTP) thresholds of $150,000/QALY, the probability of combination TTFields being cost-effective was 0%. In addition, TTFields plus SOC exhibited similar efficacy (1.12 QALYs and 1.14 QALYs) and costs ($309,822 and $312,531) in the treatment of squamous cell carcinoma (SCC) and non-squamous cell carcinoma (NSCC) populations.
In the United States, TTFields plus SOC as second-line treatment was not a more cost-effective strategy for patients with mNSCLC. Of the analyzed regimens, TTFields plus ICI was associated with most significant health benefits.
肿瘤治疗电场（TTFields）是一种新型抗肿瘤疗法，为既往接受过治疗的转移性非小细胞肺癌（mNSCLC）患者带来了显著生存获益。评估新治疗方案的成本与其疗效之间的一致性是本研究的主要目的。
收集来自3期LUNAR研究的主要参数，通过建立一个15年时间范围内的三状态马尔可夫模型，评估TTFields联合标准治疗（SOC）（免疫检查点抑制剂[ICIs]和多西他赛[DTX]）或SOC用于mNSCLC患者的成本和疗效。本研究的主要结局指标包括成本、生命年（LYs）、质量调整生命年（QALYs）和增量成本效果比（ICERs）。进行了敏感性分析。
TTFields联合SOC、TTFields联合ICI和TTFields联合DTX的总成本分别为319,358美元、338,688美元和298,477美元，分别产生1.23个QALYs、1.58个QALYs和0.89个QALYs。TTFields联合SOC对比SOC、TTFields联合ICI对比ICI、TTFields联合DTX对比DTX的ICER分别为613,379美元/QALY、387,542美元/QALY和1,359,559美元/QALY。在支付意愿（WTP）阈值为150,000美元/QALY时，TTFields联合治疗具有成本效益的概率为0%。此外，TTFields联合SOC在治疗鳞状细胞癌（SCC）和非鳞状细胞癌（NSCC）人群时表现出相似的疗效（分别为1.12个QALYs和1.14个QALYs）和成本（分别为309,822美元和312,531美元）。
在美国，TTFields联合SOC作为二线治疗方案对mNSCLC患者而言并非更具成本效益的策略。在所分析的治疗方案中，TTFields联合ICI带来的健康获益最为显著。
