Zhao Zhonghua, Jiang Xiongying, Wen Shiping, Hao Yanzhang
Department of Oncology, Binzhou Medical University Hospital, Binzhou, Shandong, China.
Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2024 Dec 6;14:1491404. doi: 10.3389/fonc.2024.1491404. eCollection 2024.
To assess the cost-effectiveness of combining camrelizumab with rivoceranib versus sorafenib as initial treatment options for advanced hepatocellular carcinoma (HCC) across different developmental regions in China.
Utilizing TreeAge Pro and data from the phase III randomized CARES-310 clinical trial, a model based on Markov state transitions was developed. Health state utility values were derived from the CARES-310 trial, and direct medical costs were obtained from relevant literature and local pricing data. The primary outcome measured was the incremental cost-effectiveness ratio (ICER), defined as the cost per additional quality-adjusted life year (QALY) gained per person. The ICERs were compared against the willingness-to-pay (WTP) thresholds of different regions in China, including low-income ($16,426.80), medium-income ($34,319.01), and high-income regions ($81,036.63). Sensitivity analyses were also conducted to assess the robustness and reliability of the model under various assumptions. A tornado diagram was used to illustrate the impact of parameter variations on the model's cost-effectiveness.
For base case analysis, QALYs per person for the cohort receiving sorafenib were 0.91, with a corresponding cost of $8,860.97. For the cohort receiving camrelizumab plus rivoceranib, the QALYs per person were 1.71, with a corresponding cost of $16,190.72. The camrelizumab plus rivoceranib treatment group exhibited an increase of 0.80 QALYs and an additional expenditure of $7,329.75. The calculated ICER was $9,150.75 per QALY, which is below the WTP thresholds for all regions in China. The camrelizumab plus rivoceranib regimen is regarded as highly cost-effective in medium-income areas of China, with a probability of 99.9%. In high-income regions, the probability reaches 100.0%. Even in low-income regions, this regimen is considered 95.6% cost-effective. Sensitivity analysis further verified that these findings were robust across various assumptions.
The combination of camrelizumab and rivoceranib as a treatment strategy not only improves health outcomes but also represents a cost-effective option across different developmental regions in China.
评估在中国不同发展地区，卡瑞利珠单抗联合瑞沃替尼与索拉非尼作为晚期肝细胞癌（HCC）初始治疗方案的成本效益。
利用TreeAge Pro软件和III期随机CARES-310临床试验的数据，开发了一个基于马尔可夫状态转移的模型。健康状态效用值来自CARES-310试验，直接医疗成本从相关文献和当地定价数据中获取。测量的主要结果是增量成本效益比（ICER），定义为每人每增加一个质量调整生命年（QALY）所花费的成本。将ICER与中国不同地区的支付意愿（WTP）阈值进行比较，包括低收入地区（16,426.80美元）、中等收入地区（34,319.01美元）和高收入地区（81,036.63美元）。还进行了敏感性分析，以评估模型在各种假设下的稳健性和可靠性。使用龙卷风图来说明参数变化对模型成本效益的影响。
在基础病例分析中，接受索拉非尼治疗的队列每人的QALY为0.91，相应成本为8,860.97美元。接受卡瑞利珠单抗加瑞沃替尼治疗的队列每人的QALY为1.71，相应成本为16,190.72美元。卡瑞利珠单抗加瑞沃替尼治疗组的QALY增加了0.80，额外支出为7,329.75美元。计算得出的ICER为每QALY 9,150.75美元，低于中国所有地区的WTP阈值。卡瑞利珠单抗加瑞沃替尼方案在中国中等收入地区被认为具有高度成本效益，概率为99.9%。在高收入地区，概率达到100.0%。即使在低收入地区，该方案也被认为成本效益为95.6%。敏感性分析进一步验证了这些发现在各种假设下都是稳健的。
卡瑞利珠单抗和瑞沃替尼联合作为一种治疗策略，不仅改善了健康结局，而且在中国不同发展地区也是一种具有成本效益的选择。
