Cost-effectiveness analysis of pembrolizumab monotherapy and chemotherapy in the non-small-cell lung cancer with different PD-L1 tumor proportion scores
Cost-effectiveness analysis of pembrolizumab monotherapy and chemotherapy in the non-small-cell lung cancer with different PD-L1 tumor proportion scores
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DOI：
10.1016/j.lungcan.2019.08.028
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发表时间：
2019-10-01
期刊：
影响因子：
5.3
通讯作者：
Li, Qiu
中科院分区：
文献类型：
--
作者：
Zhou, Kexun;Jiang, Chenlu;Li, Qiu
目的：本研究旨在从中国支付者的角度，评估帕博利珠单抗单药治疗与化疗一线治疗不同肿瘤比例评分（TPS）的局部晚期或转移性非小细胞肺癌（NSCLC）患者的成本-效果。马尔可夫模型被开发来模拟NSCLC的过程。模型输入基于已发表的临床试验和既往文献。从中国支付者的角度计算成本。进行敏感性分析，以探讨不确定性的影响。结果：与化疗相比，高TPS（>= 50%）患者的帕博利珠单抗单药治疗估计增加65，322美元的成本，增加1.79质量调整生命年（QALY）的增量成本效益比（ICER）为36，493美元。对于TPS >= 20%的患者人群，ICER为42，311美元/QALY，而对于TPS >= 1%的患者，相应的ICER为39，404美元/QALY。三个不同TPS人群的敏感性分析相似，表明帕博利珠单抗组PFS状态的成本和帕博利珠单抗的价格是我们研究中最具影响力的因素。结论：不同TPS人群中帕博利珠单抗单药治疗的ICER产量超过了我们设定的阈值，是2018年中国人均GDP（26,508美元/QALY）的3倍。从中国支付者的角度来看，无论TPS如何，与局部晚期或转移性NSCLC患者的标准化疗相比，这不是一种成本效益高的选择。目前价格的更大折扣将使pembrolizumab成为更好的选择。
Objectives: This study aimed to assess the cost-effectiveness of pembrolizumab monotherapy compared with chemotherapy as first-line treatment in patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) with different tumor proportion scores (TPS), from perspectives of payers in China.Materials and methods: Basic information was derived from the KEYNOTE-042 trial. A Markov model was developed to simulate the process of NSCLC. Model inputs were based on published clinical trials and previous literatures. Costs were calculated from perspectives of payers in China. Sensitivity analyses were conducted to explore the impact of uncertainty.Results: Treatment with pembrolizumab monotherapy for patients with high TPS (>= 50%) was estimated to increase costs by $65,322 compared with chemotherapy, with a gain of 1.79 quality adjusted life years (QALYs) for an incremental cost-effectiveness ratio (ICER) of $36,493 per QALY. For patient population with TPS >= 20%, the ICER was $42,311 per QALY, while the corresponding ICER was $39,404 per QALY for patients with TPS >= 1%. Sensitive analyses for three different TPS populations were similar, which indicated the cost of PFS state in pembrolizumab arm and the price of pembrolizumab were the most influential factors in our study.Conclusion: ICERs yield by pembrolizumab monotherapy among different TPS populations were beyond the threshold we set, three times of the Gross Domestic Product per Capita of China in 2018 ($26,508/QALY). It is not a cost effective choice compared with standard chemotherapy for patients with locally advanced or metastatic NSCLC from the perspective of Chinese payer, regardless of TPS. Deeper discount of its current price would make pembrolizumab a preferable choice.