Department of Pharmacy, Shandong Second Provincial General Hospital, Jinan, Shandong, China.
College of Pharmacy, Shandong Medical College, Jinan, Shandong, China.
Clin Ther. 2024 Nov;46(11):877-882. doi: 10.1016/j.clinthera.2024.08.016. Epub 2024 Sep 16.
Zanubrutinib, a potent and specific irreversible Bruton's tyrosine kinase inhibitor, has proven to be effective in untreated chronic lymphocytic leukemia (CLL), whether used alone or in combination with other therapies. Here, we compared the cost-effectiveness of zanubrutinib with bendamustine-rituximab (R-bendamustine) to determine its effectiveness as the first-line treatment for Chinese patients with untreated CLL.
The evaluation utilized a partitioned survival model, constructed using TreeAge Pro 2011 software, incorporating data from SEQUOIA trial (NCT03336333). Transition probabilities were estimated from the reported survival probabilities in trials using parametric survival modeling. In this analysis, the quality-adjusted life years (QALYs), incremental cost-effectiveness ratio, and lifetime cost were calculated from the Chinese health care system perspective. Sensitivity analyses, including 1-way analysis and probabilistic sensitivity analysis, were carried out to explore the uncertainty of the modeling results. Additionally, several scenario analyses, including different zanubrutinib price calculation and 20-year time horizon, were evaluated.
The findings revealed that zanubrutinib had an incremental cost-effectiveness ratio of $58,258.18 per additional QALYs gained compared with bendamustine-rituximab, with zanubrutinib being cost-effective only if its price was reduced by more than 30%. Research indicated that zanubrutinib achieved at least a 3.70% probability of cost-effectiveness at the threshold of $38,223.34/QALY. One-way sensitivity analysis revealed that the results were sensitive to the utility of progressed disease.
The study highlighted the importance of considering the cost-effectiveness of zanubrutinib at its current price point for patients with untreated CLL in China, emphasizing the need for further assessment and potential pricing adjustments to enhance its economic viability in clinical practice.
泽布替尼是一种有效的、特异性的、不可逆的布鲁顿酪氨酸激酶抑制剂，已被证明在未经治疗的慢性淋巴细胞白血病（CLL）中具有疗效，无论是单独使用还是与其他疗法联合使用。在这里，我们比较了泽布替尼与苯达莫司汀-利妥昔单抗（R-苯达莫司汀）的成本效益，以确定其作为未经治疗的中国 CLL 患者一线治疗的效果。
本评估采用分区生存模型，使用 TreeAge Pro 2011 软件构建，纳入 SEQUOIA 试验（NCT03336333）的数据。使用参数生存模型从试验报告的生存概率中估计转移概率。在这项分析中，从中国医疗保健系统的角度计算了质量调整生命年（QALYs）、增量成本效果比和终生成本。进行了敏感性分析，包括单因素分析和概率敏感性分析，以探讨模型结果的不确定性。此外，还评估了几种情景分析，包括不同的泽布替尼价格计算和 20 年时间范围。
结果表明，与苯达莫司汀-利妥昔单抗相比，泽布替尼每增加一个质量调整生命年的增量成本效果比为 58258.18 美元，只有当泽布替尼的价格降低 30%以上时，它才具有成本效益。研究表明，泽布替尼在 38223.34 美元/QALY 的阈值下至少有 3.70%的成本效果概率。单因素敏感性分析表明，结果对进展疾病的效用较为敏感。
该研究强调了在中国，考虑到目前价格点的泽布替尼的成本效益对于未经治疗的 CLL 患者的重要性，需要进一步评估和潜在的定价调整，以提高其在临床实践中的经济可行性。
