Xu Lei, Long Yunchun, Yao Lu, Wang Hao, Ge Weihong
Department of Pharmacy, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Department of Pharmacy, Meishan People 's Hospital, Meishan, Sichuan, China.
Front Oncol. 2024 Dec 16;14:1477722. doi: 10.3389/fonc.2024.1477722. eCollection 2024.
The RATIONALE-305 trial demonstrated that tislelizumab in combination with chemotherapy regimens was more beneficial than chemotherapy regimens alone in the treatment of patients with advanced gastric cancer or gastroesophageal junction adenocarcinoma (GC/GEJC). This study aimed to evaluate the cost-effectiveness of tislelizumab combination chemotherapy in the treatment of advanced GC/GEJC from the perspective of the Chinese health service system.
A three-state partition survival model was constructed to evaluate the economics of tislelizumab combined with chemotherapy as the first-line treatment of advanced GC/GEJC. Clinical data were collected from the RATIONALE-305 trial, and the incremental cost-effectiveness ratio (ICER) was calculated using quality-adjusted life years (QALYs) as the output index. The stability of the results was verified using sensitivity and subgroup analyses. In addition, scenario analysis was conducted for the model simulation time and different parameter extrapolation models.
The results of basic analysis showed an increase of 0.31 QALYs in the tislelizumab group compared with the placebo group (1.53 QALYs 1.22 QALYs), and a concomitant increase in cost of 10,326.68 USD, with an ICER of 33,876.38 USD/QALY, which is less than the current Chinese willingness-to-pay threshold (36,924.80 USD/QALY). Sensitivity analyses demonstrated that the utility values of progression-free survival, progressive disease and the price of capecitabine had a greater impact on the model. Subgroup analysis revealed that combination therapy was equally cost-effective in people with a program death ligand 1 tumor area positivity score of ≥5%.
From the perspective of the Chinese health service system, the treatment of advanced GC/GEJC with tislelizumab combined with chemotherapy has a cost-effective advantage over chemotherapy alone.
RATIONALE-305试验表明，替雷利珠单抗联合化疗方案在治疗晚期胃癌或胃食管交界腺癌（GC/GEJC）患者方面比单纯化疗方案更具优势。本研究旨在从中国医疗卫生服务体系的角度评估替雷利珠单抗联合化疗治疗晚期GC/GEJC的成本效益。
构建一个三状态分区生存模型，以评估替雷利珠单抗联合化疗作为晚期GC/GEJC一线治疗的经济性。从RATIONALE-305试验中收集临床数据，并使用质量调整生命年（QALYs）作为产出指标计算增量成本效益比（ICER）。通过敏感性和亚组分析验证结果的稳定性。此外，对模型模拟时间和不同参数外推模型进行了情景分析。
基本分析结果显示，与安慰剂组相比，替雷利珠单抗组的QALYs增加了0.31（1.53 QALYs对1.22 QALYs），成本相应增加了10,326.68美元，ICER为33,876.38美元/QALY，低于中国目前的支付意愿阈值（36,924.80美元/QALY）。敏感性分析表明，无进展生存期、疾病进展的效用值以及卡培他滨的价格对模型有更大影响。亚组分析显示，对于程序性死亡配体1肿瘤区域阳性评分≥5%的患者，联合治疗同样具有成本效益。
从中国医疗卫生服务体系的角度来看，替雷利珠单抗联合化疗治疗晚期GC/GEJC比单纯化疗具有成本效益优势。
