Difference in Cost-Effectiveness between First-Line and Third-Line or Later Nivolumab Therapy in Patients with HER2-Negative, Unresectable, Advanced or Recurrent Gastric or Gastro-Esophageal Junction Cancer in Japan
Difference in Cost-Effectiveness between First-Line and Third-Line or Later Nivolumab Therapy in Patients with HER2-Negative, Unresectable, Advanced or Recurrent Gastric or Gastro-Esophageal Junction Cancer in Japan
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DOI：
10.1248/bpb.b22-00150
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发表时间：
2022-07-01
影响因子：
2
通讯作者：
Matsushita, Ryo
中科院分区：
文献类型：
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作者：
Kashiwa, Munenobu;Matsushita, Ryo
进行了一项基于模型的成本-效果分析，以评估纳武利尤单抗（NIVO）一线治疗联合化疗与三线或更晚单药治疗不可切除、晚期或复发性胃癌或胃食管连接部癌患者的成本-效果差异，旨在支持日本医疗保健的经济评价。总生存期和无进展生存期数据来自III期临床试验ATTRACTION-4和ATTRACTION-2。开发了一个分区生存模型来预测成本和结果。直接医疗费用是从日本国民健康保险（NHI）支付者的角度考虑的。模型的时间范围定为10年。健康结果定义为获得的生命年（LY）和质量调整生命年（Q）。估计NIVO与对照组相比的增量成本-效果比（ICER）。进行敏感性分析以评估参数设置的不确定性。支付意愿阈值为1 500万日元。与每个对照组相比，一线治疗每增加1 LY的NIVO治疗ICER分别为65745714 JPY，三线或更高治疗为7420202 JPY，每增加QALY分别为74750097 JPY和10496602 JPY。概率敏感性分析估计，NIVO治疗一线和三线治疗的成本效益概率分别为23.5%和74.3%。从日本NHI支付者的角度来看，NIVO作为晚期胃癌患者的三线或更晚单药治疗具有成本效益，但与一线化疗联合使用则不具有成本效益。
A model-based, cost-effectiveness analysis was conducted to evaluate the difference in cost-effectiveness of nivolumab (NIVO), between first-line therapy in combination with chemotherapy and third-line or later monotherapy for patients with unresectable, advanced or recurrent gastric or gastro-esophageal junction cancer, with the aim of supporting the economic evaluation of healthcare in Japan. Data on overall survival and progression-free survival were obtained from the phase 3 clinical trials, ATTRACTION-4 and ATTRACTION-2. A partitioned survival model was developed to predict costs and outcomes. Direct medical costs were considered from the perspective of the Japanese national health insurance (NHI) payer. The model time horizon was set to 10 years. Health outcomes were defined as life years (LYs) and quality-adjusted life years (QALYs) gained. The incremental cost-effectiveness ratio (ICER) of NIVO compared to the control group was estimated. Sensitivity analyses were performed to assess the uncertainty of parameter setting. A willingness-to-pay threshold of 15 million JPY (Japanese yen) was used. Compared to each control group, the ICERs for NIVO treatment per 1 LY gained were 65745714 JPY for first-line treatment, 7420202 JPY for third-line or later treatment, and 74750097 JPY and 10496602 JPY per QALY gained, respectively. Probabilistic sensitivity analyses estimated that the probability of NIVO treatment being cost-effective for first-line and third-line treatment was 23.5 and 74.3%, respectively. From the perspective of the Japanese NHI payer, NIVO was cost-effective as third-line or later monotherapy for patients with advanced gastric cancer, but not in combination with first-line chemotherapy.