免疫检查点抑制剂联合靶向治疗和化疗治疗 HPV/HIV 相关宫颈癌的成本效果分析。
Cost-effectiveness analysis of immune checkpoint inhibitors combined with targeted therapy and chemotherapy for HPV/HIV-related cervical cancer.
机构信息
Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China.
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, Jiangsu, China.
出版信息
Medicine (Baltimore). 2024 Nov 29;103(48):e40678. doi: 10.1097/MD.0000000000040678.
BACKGROUND
To systematically assess the cost-effectiveness of immune checkpoint inhibitors compared to the current standard therapy for human papillomavirus (HPV) and human immunodeficiency virus (HIV)-related cervical cancer.
METHODS
A partitioned survival model spanning a 20-year period was created to evaluate the cost and effectiveness of atezolizumab combined with bevacizumab and chemotherapy (ABC), and pembrolizumab combined with bevacizumab and chemotherapy (PBC) vs bevacizumab combined with chemotherapy (BC), based on clinical data from the BEATcc and KEYNOTE-826 trials. Royston-Parmar models were used for survival estimation. Costs and health state utilities were sourced from existing literature and publicly accessible databases. Cumulative costs (in US dollars), life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured and compared. The evaluation was from the US healthcare payer perspective, with the willingness-to-pay threshold set at $100,000 to $150,000. Deterministic sensitivity analysis (DSA), probabilistic sensitivity analysis (PSA), and scenario analyses were conducted.
RESULTS
The base-case analysis showed QALYs of 2.05 for BC, 3.18 for PBC, and 2.85 for ABC. PBC increased life-years by 1.76 and ABC by 1.18, with PBC showing the highest effectiveness. Total costs were $272,377 for BC, $715,472 for ABC, and $694,239 for PBC; severe adverse event (SAE) costs were $6189 for BC, $7603.31 for ABC, and $13,640 for PBC, indicating BC had the lowest SAE costs. The ICERs compared to BC were $372,151/QALY for PBC and $553,995/QALY for ABC. Given that the willingness-to-pay threshold was $100,000 to $150,000/QALY, both PBC and ABC exceed this threshold and were not considered cost-effective. BC had the lowest QALYs and the lowest costs, making it the least expensive option and the most cost-effective choice. DSA results indicated that drug prices and utility values were the main factors affecting cost-effectiveness. PSA confirmed BC as the most cost-effective option within a willingness-to-pay threshold of $0 to $300,000, primarily because it was the least costly.
CONCLUSIONS
Immune checkpoint inhibitors significantly improve survival benefits for patients. However, their addition is costly and unlikely to be cost-effective for HPV/HIV-related metastatic cervical cancer.
背景
系统评估免疫检查点抑制剂与 HPV 和 HIV 相关宫颈癌的当前标准治疗相比的成本效益。
方法
根据 BEATcc 和 KEYNOTE-826 试验的临床数据，创建了一个 20 年跨度的分区生存模型，以评估阿替利珠单抗联合贝伐珠单抗和化疗（ABC）、帕博利珠单抗联合贝伐珠单抗和化疗（PBC）与贝伐珠单抗联合化疗（BC）的成本和效果。采用 Royston-Parmar 模型进行生存估计。成本和健康状态效用来自现有文献和公开可获得的数据库。测量和比较了累计成本（美元）、生命年、质量调整生命年（QALY）和增量成本效益比（ICER）。评估从美国医疗保健支付者的角度出发，将支付意愿阈值设定为 100,000 至 150,000 美元。进行了确定性敏感性分析（DSA）、概率敏感性分析（PSA）和情景分析。
结果
基础案例分析显示，BC 的 QALY 为 2.05，PBC 的 QALY 为 3.18，ABC 的 QALY 为 2.85。PBC 增加了 1.76 个生命年，ABC 增加了 1.18 个生命年，PBC 的效果最高。BC 的总费用为 272377 美元，ABC 的总费用为 715472 美元，PBC 的总费用为 694239 美元；严重不良事件（SAE）费用分别为 6189 美元、7603.31 美元和 13640 美元，表明 BC 的 SAE 费用最低。与 BC 相比，PBC 的 ICER 为 372151/QALY，ABC 的 ICER 为 553995/QALY。鉴于支付意愿阈值为 100,000 至 150,000/QALY，PBC 和 ABC 均超过该阈值，因此被认为不具有成本效益。BC 的 QALY 最低，成本最低，因此是最便宜的选择，也是最具成本效益的选择。DSA 结果表明，药物价格和效用值是影响成本效益的主要因素。PSA 证实，在支付意愿阈值为 0 至 300,000 美元的范围内，BC 是最具成本效益的选择，主要是因为它的成本最低。
结论
免疫检查点抑制剂可显著提高 HPV/HIV 相关转移性宫颈癌患者的生存获益。然而，其附加治疗是昂贵的，并且不太可能具有成本效益。
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