Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China.
Department of Operation Management, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Front Immunol. 2024 Sep 13;15:1426024. doi: 10.3389/fimmu.2024.1426024. eCollection 2024.
Nivolumab, recently proven in a phase 3 clinical trial (CheckMate 901) to enhance survival when combined with gemcitabine-cisplatin for advanced urothelial carcinoma. This study aimed to assess its cost-effectiveness against gemcitabine-cisplatin alone, from US and Chinese payers' perspectives.
A partitioned survival model was established to assess the life-years, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs) of nivolumab plus gemcitabine-cisplatin versus gemcitabine-cisplatin alone as first-line treatment for advanced urothelial carcinoma. Univariate, two-way, and probabilistic sensitivity analyses were conducted to assess the model's robustness. Additionally, subgroup analyses were performed.
Nivolumab plus gemcitabine-cisplatin and gemcitabine-cisplatin achieved survival benefits of 4.238 life-years and 2.979 life-years for patients with advanced urothelial carcinoma, respectively. Compared with gemcitabine-cisplatin, nivolumab plus gemcitabine-cisplatin resulted in ICERs of $116,856/QALY in the US and $51,997/QALY in China. The probabilities of achieving cost-effectiveness at the current willingness-to-pay thresholds were 77.5% in the US and 16.5% in China. Cost-effectiveness could be reached if the price of nivolumab were reduced to $920.87/100mg in China. Subgroup analyses indicated that the combination had the highest probability of cost-effectiveness in patients under 65 or with an Eastern Cooperative Oncology Group (ECOG) performance-status score of 0 in the US and China.
Nivolumab plus gemcitabine-cisplatin first-line treatment for advanced urothelial carcinoma results in longer life expectancy than gemcitabine-cisplatin, but is not cost-effective in China at current price. However, cost-effectiveness is likely to be achieved in most patient subgroups in the US.
纳武利尤单抗在 III 期临床试验（CheckMate 901）中已被证实与吉西他滨联合顺铂联合治疗晚期尿路上皮癌可提高生存率。本研究旨在从美国和中国支付者的角度评估其与吉西他滨联合顺铂单独使用相比的成本效益。
建立了一个分割生存模型，以评估纳武利尤单抗联合吉西他滨联合顺铂与吉西他滨联合顺铂单独作为晚期尿路上皮癌一线治疗的生命年、质量调整生命年（QALYs）、终生成本和增量成本效益比（ICERs）。进行了单变量、双向和概率敏感性分析，以评估模型的稳健性。此外，还进行了亚组分析。
纳武利尤单抗联合吉西他滨联合顺铂和吉西他滨联合顺铂分别为晚期尿路上皮癌患者带来了 4.238 年和 2.979 年的生存获益。与吉西他滨联合顺铂相比，纳武利尤单抗联合吉西他滨联合顺铂在美国的 ICER 为 116856 美元/QALY，在中国的 ICER 为 51997 美元/QALY。在当前的支付意愿阈值下，达到成本效益的概率分别为美国 77.5%和中国 16.5%。如果纳武利尤单抗在中国的价格降至 920.87 美元/100mg，则可能达到成本效益。亚组分析表明，在美国和中国，该联合疗法在 65 岁以下或东部合作肿瘤学组（ECOG）表现状态评分为 0 的患者中具有最高的成本效益可能性。
纳武利尤单抗联合吉西他滨联合顺铂一线治疗晚期尿路上皮癌可延长预期寿命，但在中国，目前的价格并不具有成本效益。然而，在美国的大多数患者亚组中，可能达到成本效益。
