Epsilon Research, Santiago, Chile.
Departamento de Salud Pública - Pontificia Universidad Católica de Chile, Santiago, Chile.
PLoS One. 2024 Jul 26;19(7):e0307473. doi: 10.1371/journal.pone.0307473. eCollection 2024.
Durvalumab, used as consolidation immunotherapy, has shown to improve survival in patients with stage III non-small cell lung cancer who respond to chemoradiotherapy, based on the most recent follow-up of PACIFIC. The Chilean healthcare system provides access to certain immunotherapies for this condition. The present study sought to estimate the budget impact of durvalumab versus standard of care in the context of the Chilean healthcare system.
A partitioned survival model was adapted to compare two strategies: durvalumab as consolidation therapy and standard of care for treating stage III NSCLC. The number of patients eligible for treatment was estimated using published incidence data and modeled for a 5-year time horizon. Model inputs were based on published literature, and the duration of treatment was estimated using survival curves obtained from PACIFIC. Costs were estimated in Chilean pesos (CLP) and converted to USD dollars using an exchange rate of USD 1 = CLP 827. Scenario analyses were performed to assess different subsequent therapy splits, variations in the target population and dosage of durvalumab.
Durvalumab uptake projected total costs ranging from USD 1.27 in Year 1 to 8.5 million in Year 5 from the public perspective. From the private perspective, the budget impact for the first year is USD 1.3 million to USD 3 million for 2028. This difference relies mostly on the lower number of patients treated. Both perspectives anticipated cost savings over the time horizon through reduced monitoring, adverse events, and end-of-life expenses.
This study demonstrates that the inclusion of Durvalumab for NSCLC in Chile represents an investment in the Chilean health system. The incremental costs align with clinical benefits and potential savings in healthcare resource utilization. However, a comprehensive cost-effectiveness analysis is needed to evaluate its economic value thoroughly.
基于 PACIFIC 的最新随访结果，度伐利尤单抗作为巩固免疫疗法，已显示出可改善对放化疗有反应的 III 期非小细胞肺癌患者的生存。智利的医疗保健系统为这种疾病提供了某些免疫疗法的渠道。本研究旨在估算度伐利尤单抗与智利医疗保健系统标准护理相比的预算影响。
对一个分区生存模型进行了调整，以比较两种策略：度伐利尤单抗作为巩固治疗和标准护理治疗 III 期 NSCLC。使用已发表的发病率数据来估算符合治疗条件的患者人数，并对 5 年时间范围内进行建模。模型输入基于已发表的文献，治疗持续时间使用从 PACIFIC 获得的生存曲线来估计。成本以智利比索（CLP）估算，并使用 1 美元=827 智利比索的汇率转换为美元。进行了方案分析，以评估不同的后续治疗分配、目标人群的变化以及度伐利尤单抗的剂量。
从公共角度来看，度伐利尤单抗的采用预计在第 1 年的总成本为 1.27 亿美元，在第 5 年的总成本为 850 万美元。从私人角度来看，2028 年第一年的预算影响为 130 万至 300 万美元。这种差异主要依赖于治疗患者人数的减少。从长远来看，两种观点都预计通过减少监测、不良事件和临终费用来节省成本。
本研究表明，在智利将度伐利尤单抗纳入 NSCLC 的治疗代表了对智利卫生系统的投资。增量成本与临床效益以及医疗资源利用的潜在节省相符。然而，需要进行全面的成本效益分析，以彻底评估其经济价值。
