局限期小细胞肺癌患者放化疗后度伐利尤单抗巩固治疗的国际成本效益分析
International cost-effectiveness analysis of durvalumab consolidation treatment after chemoradiotherapy for patients with limited-stage small-cell lung cancer.
作者信息
Liu Kun, Zhu Youwen, Zhu Hong
机构信息
Department of Oncology, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
出版信息
Transl Lung Cancer Res. 2025 Aug 31;14(8):2942-2953. doi: 10.21037/tlcr-2025-354. Epub 2025 Aug 11.
BACKGROUND
The recently conducted ADRIATIC trial demonstrated that adding durvalumab led to significant improvements in the survival of non-advanced limited-stage small cell lung cancer (LS-SCLC) following concurrent chemoradiotherapy (CCRT). While efficacious, immunotherapeutic drugs are associated with high costs. Therefore, the purpose of this study is to conduct pharmacoeconomic analyses of the cost-effectiveness of durvalumab consolidation treatment after CCRT for LS-SCLC from the perspective of payers in specific countries.
METHODS
The costs and efficacy of consolidation durvalumab versus placebo treatment following CCRT for LS-SCLC patients were analyzed using a three-state Markov model. The lifetime direct medical costs, incremental cost-effectiveness ratios (ICERs), incremental cost-utility ratios (ICURs), and incremental net-health benefit (INHB) associated with these treatment strategies were evaluated from the perspective of payers in China and the USA (the primary source countries for patients in the ADRIATIC trial) at respective willingness-to-pay (WTP) thresholds of $37,023 and $150,000 per quality-adjusted life-year (QALY). Sensitivity and subgroup analyses were used to assess model stability.
RESULTS
Durvalumab consolidation was associated with 2.24 and 2.80 incremental QALYs relative to placebo for patients in China and the USA, but it was also associated with significant increases in lifetime medical costs ($48,511 $18,769 and $403,946 $154,579), for corresponding ICURs of $13,257/QALY and $89,079/QALY in China and the USA. Sensitivity analyses supported the stability of the established model, while subgroup analyses indicated that durvalumab consolidation was recommended within 2 weeks of CCRT.
CONCLUSIONS
Durvalumab consolidation following CCRT represents a cost-effective option for the treatment of LS-SCLC patients in China and the USA.
背景
最近开展的ADRIATIC试验表明，在同步放化疗（CCRT）后加用度伐利尤单抗可显著提高非晚期局限期小细胞肺癌（LS-SCLC）患者的生存率。虽然免疫治疗药物有效，但成本高昂。因此，本研究旨在从特定国家支付方的角度，对CCRT后度伐利尤单抗巩固治疗LS-SCLC的成本效益进行药物经济学分析。
方法
采用三状态马尔可夫模型分析LS-SCLC患者CCRT后巩固用度伐利尤单抗与安慰剂治疗的成本和疗效。从中国和美国（ADRIATIC试验中患者的主要来源国）支付方的角度，在每质量调整生命年（QALY）分别为37,023美元和150,000美元的支付意愿（WTP）阈值下，评估与这些治疗策略相关的终身直接医疗成本、增量成本效益比（ICER）、增量成本效用比（ICUR）和增量净健康效益（INHB）。采用敏感性分析和亚组分析评估模型稳定性。
结果
在中国和美国，相对于安慰剂，度伐利尤单抗巩固治疗分别使患者的QALY增加2.24和2.80，但也使终身医疗成本显著增加（中国为48,511美元对18,769美元，美国为403,946美元对154,579美元），中国和美国相应的ICUR分别为13,257美元/QALY和89,079美元/QALY。敏感性分析支持所建立模型的稳定性，而亚组分析表明，在CCRT后2周内推荐使用度伐利尤单抗巩固治疗。
结论
CCRT后度伐利尤单抗巩固治疗是中国和美国治疗LS-SCLC患者的一种具有成本效益的选择。
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