卡度尼利单抗联合化疗一线治疗HER2阴性晚期胃癌或胃食管交界腺癌的成本效益
Cost-effectiveness of cadonilimab plus chemotherapy in the first-line treatment of HER2-negative advanced gastric or gastroesophageal junction adenocarcinoma.
作者信息
Liu Shixian, Wang Kaixuan, Wang Ruixue, Chen Hao, Wan Ziming, Dou Lei, Li Shunping
机构信息
Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
出版信息
Therap Adv Gastroenterol. 2025 Aug 18;18:17562848251366946. doi: 10.1177/17562848251366946. eCollection 2025.
BACKGROUND
The COMPASSION-15 clinical trial demonstrated that cadonilimab plus chemotherapy significantly improved clinical benefits in human epidermal growth factor receptor 2-negative (HER2-) advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma.
OBJECTIVES
This study investigated the cost-effectiveness of cadonilimab plus chemotherapy in the first-line treatment for HER2- advanced G/GEJ adenocarcinoma from the Chinese healthcare system perspective.
DESIGN
Economic evaluation.
METHODS
We compared three treatment regimens based on the COMPASSION-15 trial, including chemotherapy, cadonilimab plus chemotherapy, and programmed death ligand 1 (PD-L1) test-guided treatment. A partitioned survival model was constructed at 21-day cycle lengths over a 10-year time horizon to predict total costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) under the willingness-to-pay (WTP) threshold of three times the gross domestic product per capita ($40,334.05). Model parameters were obtained from a public bid-winning database and published literature. Scenario, one-way, and probabilistic sensitivity analyses were used to test the robustness of the model.
RESULTS
In the base case, the costs of chemotherapy, PD-L1 test-guided treatment, and cadonilimab plus chemotherapy were $7,207.78, $15,776.35, and $22,294.58, with QALYs of 0.59, 0.71, and 0.79, respectively. The ICERs of PD-L1 test-guided treatment and cadonilimab plus chemotherapy were $68,751.00 and $76,120.27 per QALY. The ICERs of cadonilimab plus chemotherapy were $58,469.16 and $121,123.92 per QALY for PD-L1 combined positive score (CPS) ⩾ 5 and <5 HER2- advanced G/GEJ adenocarcinoma. The cost of cadonilimab and patient weight were the most influential model parameters. Cadonilimab plus chemotherapy had a 0.01% cost-effectiveness in China.
CONCLUSION
Cadonilimab plus chemotherapy might be a cost-effective regimen when the unit cost of cadonilimab was $151.48 (58% discount) and $188.04 (72% discount) for overall and PD-L1 CPS ⩾ 5 advanced G/GEJ adenocarcinoma.
背景
COMPASSION - 15临床试验表明，卡度尼利单抗联合化疗显著改善了人表皮生长因子受体2阴性（HER2-）晚期胃癌或胃食管交界（G/GEJ）腺癌的临床获益。
目的
本研究从中国医疗保健系统的角度，调查卡度尼利单抗联合化疗用于HER2-晚期G/GEJ腺癌一线治疗的成本效益。
设计
经济学评价。
方法
基于COMPASSION - 15试验，我们比较了三种治疗方案，包括化疗、卡度尼利单抗联合化疗以及程序性死亡配体1（PD - L1）检测指导治疗。构建了一个以21天为周期长度、为期10年的分割生存模型，以预测在人均国内生产总值三倍（40,334.05美元）的支付意愿（WTP）阈值下的总成本、生命年、质量调整生命年（QALY）和增量成本效益比（ICER）。模型参数来自一个中标数据库和已发表的文献。采用情景分析、单因素分析和概率敏感性分析来检验模型的稳健性。
结果
在基础案例中，化疗、PD - L1检测指导治疗和卡度尼利单抗联合化疗的成本分别为7,207.78美元、15,776.35美元和22,294.58美元，QALY分别为0.59、0.71和0.79。PD - L1检测指导治疗和卡度尼利单抗联合化疗的ICER分别为每QALY 68,751.00美元和76,120.27美元。对于PD - L1联合阳性评分（CPS）⩾5和<5的HER2-晚期G/GEJ腺癌，卡度尼利单抗联合化疗的ICER分别为每QALY 58,469.16美元和121,123.92美元。卡度尼利单抗的成本和患者体重是最具影响力的模型参数。在中国，卡度尼利单抗联合化疗具有0.01%的成本效益。
结论
当卡度尼利单抗的单位成本分别为151.48美元（58%折扣）和188.04美元（72%折扣）时，对于总体和PD - L1 CPS⩾5的晚期G/GEJ腺癌，卡度尼利单抗联合化疗可能是一种具有成本效益的方案。
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