Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Front Immunol. 2024 Jul 5;15:1408928. doi: 10.3389/fimmu.2024.1408928. eCollection 2024.
To determine the cost-effectiveness of imported immune checkpoint inhibitors (ICIs) such as atezolizumab and durvalumab, and domestic ICIs like serplulimab and adebrelimab, in combination with chemotherapy for extensive-stage small cell lung cancer (ES-SCLC) in China.
Using a 21-day cycle length and a 20-year time horizon, a Markov model was established to compare the clinical and economic outcomes of five first-line ICIs plus chemotherapy versus chemotherapy alone, as well as against each other, from the perspective of the Chinese healthcare system. Transition probabilities were estimated by combining the results of the CAPSTONE-1 trial and a published network meta-analysis. Cost and health state utilities were collected from multiple sources. Both cost and effectiveness outcomes were discounted at a rate of 5% annually. The primary model output was incremental cost-effectiveness ratios (ICERs). A series of sensitivity analyses were preformed to assess the robustness of the model.
In the base-case analysis, the addition of first-line ICIs to chemotherapy resulted in the ICERs ranged from $80,425.31/QALY to $812,415.46/QALY, which exceeded the willing-to-pay threshold set for the model. When comparing these first-line immunochemotherapy strategies, serplulimab plus chemotherapy had the highest QALYs of 1.51286 and the second lowest costs of $60,519.52, making it is the most cost-effective strategy. Our subgroup-level analysis yielded results that are consistent with the base-case analysis. The sensitivity analysis results confirmed the validity and reliability of the model.
In China, the combination of fist-line ICIs plus chemotherapy were not considered cost-effective when compared to chemotherapy alone. However, when these fist-line immunochemotherapy strategies were compared with each other, first-line serplulimab plus chemotherapy consistently demonstrated superiority in terms of cost-effectiveness. Reducing the cost of serplulimab per 4.5 mg/kg would be a realistic step towards making first-line serplulimab plus chemotherapy more accessible and cost-effective.
旨在评估进口免疫检查点抑制剂（ICI），如阿替利珠单抗和度伐利尤单抗，以及国产 ICI，如赛普丽珠单抗和阿得贝利单抗联合化疗，用于中国广泛期小细胞肺癌（ES-SCLC）的成本效益。
采用 21 天治疗周期和 20 年时间范围，建立马尔可夫模型，从中国医疗保健系统的角度，比较五种一线 ICI 联合化疗与单纯化疗相比，以及彼此之间的临床和经济结果。使用 CAPSTONE-1 试验和已发表的网络荟萃分析的结果相结合，估算转移概率。从多个来源收集成本和健康状态效用。均以 5%的年率对成本和效果结果进行贴现。主要模型输出是增量成本效益比（ICER）。进行了一系列敏感性分析，以评估模型的稳健性。
在基准分析中，一线 ICI 联合化疗的附加治疗导致增量成本效益比（ICER）范围为 80425.31 美元/QALY 至 812415.46 美元/QALY，超过了模型设定的意愿支付阈值。当比较这些一线免疫化疗策略时，赛普丽珠单抗联合化疗具有最高的 QALY（1.51286）和第二低的成本（60519.52 美元），使其成为最具成本效益的策略。我们的亚组水平分析结果与基准分析一致。敏感性分析结果证实了模型的有效性和可靠性。
在中国，与单纯化疗相比，一线 ICI 联合化疗的方案不具有成本效益。然而，当比较这些一线免疫化疗策略时，赛普丽珠单抗联合化疗在成本效益方面始终具有优势。降低赛普丽珠单抗每 4.5mg/kg 的成本将是使其更普及和更具成本效益的现实步骤。
