First-line atezolizumab plus chemotherapy in treatment of extensive small cell lung cancer: a cost-effectiveness analysis from China
First-line atezolizumab plus chemotherapy in treatment of extensive small cell lung cancer: a cost-effectiveness analysis from China
复制标题
一线阿替珠单抗联合化疗治疗广泛性小细胞肺癌：来自中国的成本效益分析
DOI：
10.1097/cm9.0000000000000536
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发表时间：
2019-12-05
影响因子：
6.1
通讯作者：
Cui, Jiu-Wei
中科院分区：
文献类型：
--
作者：
Li, Ling-Yu;Wang, Hong;Cui, Jiu-Wei
背景：IMpower 133试验首次证实了在广泛期小细胞肺癌（SCLC）患者的一线化疗中添加atezolizumab或安慰剂的疗效和安全性。但由于价格昂贵，限制了其在临床上的广泛应用。本研究的目的是评估atezolizumab联合化疗一线治疗中国广泛期SCLC.Methods的成本-效果，通过提取IMpower133试验的数据，未经治疗的广泛期SCLC患者建立马尔可夫模型。效用值从已发表的研究中获得，成本从真实的世界和文献中获得。此外，基于支付意愿（WTP）阈值进行敏感性分析，以确定马尔可夫模型的不确定参数。结果：atezolizumab组的总成本为48,129美元，而安慰剂组仅化疗的成本为12,920美元。atezolizumab组的质量调整生命年（Qs）仅比安慰剂组高0.072（0.858 Qs vs. 0.786 Qs）。在中国，atezolizumab联合化疗与单纯化疗的成本-效果比为489，013美元/QALY。安慰剂组的净获益显著高于atezolizumab组。单因素敏感性分析显示，安慰剂组的无进展生存期（PFS）和疾病进展状态的效用是最具影响力的参数。结论：Atezolizumab联合治疗在中国的WTP阈值为25，929美元/QALY时，并不比单纯化疗更具成本效益。
Background:IMpower 133 trial first confirmed the efficacy and safety of adding atezolizumab or placebo to first-line treatment with chemotherapy in patients with extensive-stage small-cell lung cancer (SCLC). While, overprice limited its broad use in clinical. The aim of this study was to evaluate the cost-effectiveness of atezolizumab plus chemotherapy in treatment of extensive SCLC as first line in China.Methods:A Markov model was established by extracting data from the IMpower 133 trial with untreated extensive SCLC patients. Utility values were obtained from published studies, and the costs were acquired from real world and literature. Additionally, sensitivity analyses based on a willingness-to-pay (WTP) threshold were performed to identify the uncertain parameters of Markov model.Results:Total costs of atezolizumab group were $48,129, while cost of chemotherapy alone was just $12,920 in placebo group. The quality-adjusted life-years (QALYs) in atezolizumab group was just 0.072 higher than that in placebo group (0.858 QALYs vs. 0.786 QALYs). The cost-effectiveness ratio between atezolizumab combination with chemotherapy and chemotherapy alone was $489,013/QALY in China. The net benefit of placebo group was significantly higher than atezolizumab group. One-way sensitivity analyses highlighted that utilities of the progression-free survival (PFS) and progression disease state in placebo group were the most influential parameter.Conclusions:Atezolizumab combination therapy was not more cost-effective than chemotherapy alone at a WTP threshold of $25,929/QALY in China.