A Trial-Based Assessment of the Cost-Utility of Bevacizumab and Chemotherapy versus Chemotherapy Alone for Advanced Non-Small Cell Lung Cancer
A Trial-Based Assessment of the Cost-Utility of Bevacizumab and Chemotherapy versus Chemotherapy Alone for Advanced Non-Small Cell Lung Cancer
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DOI：
10.1016/j.jval.2011.04.004
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发表时间：
2011-09-01
期刊：
影响因子：
4.5
通讯作者：
Ramsey, Scott
中科院分区：
文献类型：
--
作者：
Goulart, Bernardo;Ramsey, Scott
目的：基于一项随机试验证明的 2 个月中位生存获益，贝伐珠单抗被批准与化疗联合治疗晚期非小细胞肺癌 (NSCLC)。在晚期 NSCLC 化疗中添加贝伐珠单抗的成本效益仍不清楚。我们评估了晚期 NSCLC 患者化疗中添加贝伐珠单抗的成本效益。方法：我们开发了一个马尔可夫模型，从美国付款人的角度估计接受贝伐单抗联合化疗的患者的质量调整生命年 (QALY) 和直接医疗费用，并将这些结果与仅接受化疗的患者进行比较。我们用比较这两种策略的临床试验的生存和毒性数据填充模型。我们通过文献检索获得了效用，并从 Medicare 获得了单位成本。我们每年对 QALY 和成本进行 3% 的折扣。我们通过单向和概率敏感性分析来解决不确定性。结果：与单独化疗相比，贝伐珠单抗和化疗使平均 QALY 提高了 0.13，每位患者的终生成本增量为 72,000 美元。增量成本效用比 (ICUR) 为 560,000 美元/QALY。 ICUR 对贝伐单抗治疗的生存率、贝伐单抗的药物成本以及疾病稳定治疗的效用最为敏感。在 100,000 美元/QALY 的阈值下，添加贝伐单抗具有成本效益的概率为 0.2%。结论：根据美国已确定的大致成本效益阈值，贝伐单抗在晚期 NSCLC 患者的化疗中添加时似乎不具有成本效益。这些结果可以为决策者提供有关非小细胞肺癌治疗资源分配的信息。
Objectives: Bevacizumab is approved for treatment of advanced non-small cell lung cancer (NSCLC) in combination with chemotherapy based on a 2-month median survival benefit demonstrated in one randomized trial. The cost-utility of adding bevacizumab to chemotherapy in advanced NSCLC remains unknown. We evaluated the cost-utility of bevacizumab added to chemotherapy in patients with advanced NSCLC. Methods: We developed a Markov model to estimate quality-adjusted life years (QALYs) and direct medical costs from the US payer perspective in patients treated with bevacizumab plus chemotherapy and compared these outcomes with patients treated with chemotherapy alone. We populated the model with survival and toxicity data from the clinical trial that compared the two strategies. We obtained utilities from a literature search and unit costs from Medicare. We discounted QALYs and costs at 3% per year. We addressed uncertainty with one-way and probabilistic sensitivity analyzes. Results: Compared with chemo-therapy alone, bevacizumab and chemotherapy increased mean QALYs by 0.13, at an incremental life-time cost of US$72,000 per patient. The incremental cost-utility ratio (ICUR) was US$560,000/QALY. The ICUR was most sensitive to the survival on bevacizumab treatment, the drug costs of bevacizumab, and the utility of stable disease on treatment. At a threshold of US$100,000/QALY, the addition of bevacizumab had a 0.2% probability of being cost-effective. Conclusions: Bevacizumab does not appear to be cost-effective when added to chemotherapy in patients with advanced NSCLC, based on approximate cost-effectiveness thresholds that have been identified in the United States. These results may inform decision-makers about resource allocation for NSCLC care.