Lin Yingtao, Li Cijuan, Wang Chang, Chen Jian, Huang Yuanqing
Clinical Medical Research Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China.
Department of Comprehensive Surgery, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, China.
Front Immunol. 2024 Nov 27;15:1481584. doi: 10.3389/fimmu.2024.1481584. eCollection 2024.
Medication is the predominant therapy for advanced cancers. However, the use of novel anticancer medications is a major contributor to disease-related financial hardships. Recently, numerous countries have mandated the pharmacoeconomic assessments of novel oncological agents to mitigate patient financial risks and optimize resource allocation. The present study evaluated the cost-effectiveness of adding atezolizumab to standard therapy (atezolizumab plus bevacizumab [BC]) for metastatic, persistent, and recurrent cervical cancer from the perspective of US healthcare payers, with the aim of supporting policymaking and promoting the rational use of healthcare resources.
Using clinical efficacy and safety data from the BEATcc clinical trial, in addition to cost and utility values from publicly available databases and published literature, a partitioned survival model over a 20-year lifetime horizon was developed to assess the cost-effectiveness of atezolizumab plus bevacizumab and chemotherapy (ABC) versus BC. The primary output of the model was the incremental cost-effectiveness ratio (ICER) and sensitivity analyses were performed to assess its robustness.
At both 20 and 4.5 y of time horizon, ABC therapy showed poor cost-effectiveness, with ICER of $193926.48/QALY and $168482.26/QALY, respectively, which were higher than the $150,000/QALY willingness-to-pay threshold. One-way sensitivity analysis showed that the price of atezolizumab had the most significant impact on the model results. When the price of atezolizumab was reduced by 10%, ABC changed from being not cost-effective to cost-effective (ICER = $121531.24/QALY). Probabilistic sensitivity analysis showed a 32.6% probability that ABC would be cost-effective, which increased to 58.6% when the price of atezolizumab was reduced by 10%.
For patients with metastatic, persistent, and recurrent cervical cancer in the US, ABC was not as cost-effective as BC. Appropriate price reduction (10%) is recommended for atezolizumab to improve cost-effectiveness of ABC therapy.
药物治疗是晚期癌症的主要治疗方法。然而，新型抗癌药物的使用是导致疾病相关经济困难的主要因素。最近，许多国家已强制要求对新型肿瘤药物进行药物经济学评估，以减轻患者的经济风险并优化资源配置。本研究从美国医疗支付方的角度评估了在标准治疗（阿替利珠单抗加贝伐单抗[BC]）基础上加用阿替利珠单抗治疗转移性、持续性和复发性宫颈癌的成本效益，旨在支持政策制定并促进医疗资源的合理使用。
利用BEATcc临床试验的临床疗效和安全性数据，以及公开可用数据库和已发表文献中的成本和效用值，建立了一个为期20年的分区生存模型，以评估阿替利珠单抗加贝伐单抗与化疗（ABC）对比BC的成本效益。该模型的主要输出结果是增量成本效益比（ICER），并进行了敏感性分析以评估其稳健性。
在20年和4.5年的时间范围内，ABC治疗的成本效益均较差，ICER分别为193926.48美元/质量调整生命年和168482.26美元/质量调整生命年，均高于150000美元/质量调整生命年的支付意愿阈值。单向敏感性分析表明，阿替利珠单抗的价格对模型结果影响最为显著。当阿替利珠单抗价格降低10%时，ABC从成本效益不佳变为具有成本效益（ICER = 121531.24美元/质量调整生命年）。概率敏感性分析显示，ABC具有成本效益的概率为32.6%，当阿替利珠单抗价格降低10%时，该概率增至58.6%。
对于美国转移性、持续性和复发性宫颈癌患者，ABC的成本效益不如BC。建议阿替利珠单抗适当降价（10%）以提高ABC治疗的成本效益。
