Cost-Effectiveness of Nab-Paclitaxel and Gemcitabine Versus Gemcitabine Monotherapy for Patients with Unresectable Metastatic Pancreatic Cancer in Japan
Cost-Effectiveness of Nab-Paclitaxel and Gemcitabine Versus Gemcitabine Monotherapy for Patients with Unresectable Metastatic Pancreatic Cancer in Japan
复制标题
白蛋白结合型紫杉醇和吉西他滨与吉西他滨单一疗法治疗日本不可切除的转移性胰腺癌患者的成本效益
DOI：
10.1016/j.vhri.2021.04.003
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Shimozuma K
中科院分区：
文献类型：
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作者：
Morimoto K;Moriwaki K;Kaneyasu T;Nakayama H;Shimozuma K
目的本研究的目的是从医疗保健支付者的角度评价日本不可切除的转移性胰腺癌患者使用白蛋白结合型紫杉醇和吉西他滨（GNP）与吉西他滨单药治疗（G）相比的成本-效果。方法建立分割生存分析模型，预测GnP和G的成本和质量调整生命年（QDs）。该模型的时间范围定为20年。成本及季度报告均采用2%的年度贴现率。总生存期和无进展生存期数据来自转移性胰腺癌临床试验。费用参数是根据日本医疗索赔数据库估算的。估计了GnP与G相比的增量成本效果比（ICER）。进行了单因素敏感性分析，以评估参数设置的不确定性。此外，还进行了情景和概率敏感性分析。结果GNP组与G组相比，增加成本为25089美元，QALY为0.13QALY。GNP的ICER估计为192 992美元/QALY。尽管ICER受到效用参数和生存曲线的影响，但ICER仍高于68000美元（750万日元）的支付意愿（WTP）阈值。与G相比，GNP变得具有成本效益的概率估计为29.2%。结论从医疗保健支付者的角度来看，应用68 000美元/QALY的WTP阈值，GNP对日本不可切除的转移性胰腺癌患者不具有成本效益。需要进一步研究以获得日本胰腺癌患者的效用数据。
Objectives The purpose of this study was to evaluate the cost-effectiveness of nab-paclitaxel and gemcitabine (GnP) compared with gemcitabine monotherapy (G) for patients with unresectable metastatic pancreatic cancer in Japan from the perspective of healthcare payer. Methods A partitioned survival analysis model was developed to predict costs and quality-adjusted life years (QALYs) for GnP and G. The time horizon of the model was set at 20 years. An annual discount rate of 2% for both costs and QALYs was applied. Data on overall survival and progression-free survival were derived from the Metastatic Pancreatic Adenocarcinoma Clinical Trial. Cost parameters were estimated from a Japanese medical claims database. The incremental cost-effectiveness ratio (ICER) of GnP compared with G was estimated. One-way sensitivity analysis was performed to assess the uncertainty in the parameter settings. In addition, scenario and probability sensitivity analyses were performed. Results The incremental cost and QALY of GnP compared with G were US $25 089 and 0.13 QALY, respectively. The ICER of GnP was estimated to be US $192 992 per QALY gained. Although the ICER was influenced by utility parameters and the survival curves, the ICERs remained higher than the willingness to pay (WTP) threshold of US $68 000 (JPY 7.5 million). The probability that GnP becomes cost-effective compared with G was estimated to be 29.2%. Conclusions Applying the WTP threshold of US $68 000 per QALY, GnP was not cost-effective for patients with unresectable metastatic pancreatic cancer in Japan from the perspective of healthcare payer. Further research is needed to obtain utility data from Japanese patients with pancreatic cancer.