Cost-utility analysis of bevacizumab combined with erlotinib in the first-line treatment of advanced <italic style="font-style: italic">EGFR</italic> mutant non-squamous NSCLC

JU Wenxiang; ZHAO Yingying; LU Luolan; ZHANG Xiaohan; SHEN Aizong

doi:10.6039/j.issn.1001-0408.2024.11.13

您当前的位置：

首页 >

文章列表页 >

Cost-utility analysis of bevacizumab combined with erlotinib in the first-line treatment of advanced EGFR mutant non-squamous NSCLC

更新时间：2024-06-11

- Cost-utility analysis of bevacizumab combined with erlotinib in the first-line treatment of advanced EGFR mutant non-squamous NSCLC
- ZHONGGUO YAOFANG Vol. 35, Issue 11, Pages: 1357-1362(2024)
- 作者机构：
  
  1.安徽中医药大学药学院，合肥　230012
  2.安徽省药品临床综合评价技术中心，合肥　230001
  3.精准药物制剂与临床药学安徽省重点实验室，合肥　230001
  4.公共健康社会治理安徽省哲学社会科学重点实验室，合肥　230032
  5.质谱关键技术研发与临床应用安徽省联合共建学科重点实验室，合肥　230088
  6.中国科学技术大学附属第一医院药学部，合肥　230001
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2024.11.13
  CLC： R956;R979.1
- Published：15 June 2024，
  
  Received：28 October 2023，
  
  Revised：21 April 2024，
扫描看全文
居文祥,赵荧荧,路萝兰等.贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状NSCLC的成本-效用分析 ^Δ[J].中国药房,2024,35(11):1357-1362.

JU Wenxiang,ZHAO Yingying,LU Luolan,et al.Cost-utility analysis of bevacizumab combined with erlotinib in the first-line treatment of advanced EGFR mutant non-squamous NSCLC[J].ZHONGGUO YAOFANG,2024,35(11):1357-1362.
居文祥,赵荧荧,路萝兰等.贝伐珠单抗联合厄洛替尼一线治疗晚期EGFR突变型非鳞状NSCLC的成本-效用分析 ^Δ[J].中国药房,2024,35(11):1357-1362. DOI： 10.6039/j.issn.1001-0408.2024.11.13.

JU Wenxiang,ZHAO Yingying,LU Luolan,et al.Cost-utility analysis of bevacizumab combined with erlotinib in the first-line treatment of advanced EGFR mutant non-squamous NSCLC[J].ZHONGGUO YAOFANG,2024,35(11):1357-1362. DOI： 10.6039/j.issn.1001-0408.2024.11.13.

摘要

目的

从我国卫生体系角度出发，评价贝伐珠单抗联合厄洛替尼一线治疗晚期

EGFR

突变型非鳞状非小细胞

肺癌（NSCLC）的经济性。

方法

基于BEVERLY研究数据构建动态Markov模型，循环周期为3周，模拟至模型中99%的患者死亡，年贴现率为5%。模型产出为总成本与质量调整生命年（QALY）以及增量成本-效果比（ICER）。以3倍我国2023年人均国内生产总值（GDP）作为意愿支付（WTP）阈值，采用成本-效用分析法评价贝伐珠单抗联合厄洛替尼相对于厄洛替尼单药一线治疗晚期

EGFR

突变型非鳞状NSCLC的经济性，并采用单因素敏感性分析和概率敏感性分析验证基础分析结果的稳健性。

结果

基础分析结果显示，与厄洛替尼单药方案相比，贝伐珠单抗联合厄洛替尼方案的ICER为1 452 243.01 元/QALY，大于以3倍我国2023年人均GDP（268 074元/QALY）作为的WTP阈值，不具有经济性。单因素敏感性分析结果显示，贝伐珠单抗成本、无进展生存期和疾病进展期状态的效用值对结果的影响较大。概率敏感性分析结果显示，当WTP阈值为1 740 000元/QALY时，贝伐珠单抗联合厄洛替尼方案具有经济性的概率为50%。

结论

在以3倍我国2023年人均GDP作为WTP阈值时，与厄洛替尼单药方案相比，贝伐珠单抗联合厄洛替尼一线治疗晚期

EGFR

突变型非鳞状NSCLC不具有经济性。

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of bevacizumab combined with erlotinib in the first-line treatment of advanced

EGFR

mutant non-squamous non-small cell lung cancer （NSCLC） from the perspective of China’s health system.

METHODS

A dynamic Markov model was established based on BEVERLY study data， with a cycle of 3 weeks， a research deadline until 99% of patients die， and an annual discount rate of 5%. The model outputs were total cost， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Taking 3 times China’s per capita gross domestic product （GDP） in 2023 as the willingness-to-pay （WTP） threshold， the cost-utility analysis was used to evaluate the cost-effectiveness of bevacizumab combined with erlotinib （observation group） versus erlotinib alone （control group） in the first-line treatment of advanced

EGFR

mutant non-squamous NSCLC， and the single factor sensitivity analysis and probability sensitivity analysis were used to verify the robustness of the basic analysis results.

RESULTS

The results of the basic analysis showed that compared with the erlotinib therapy plan， ICER of bevacizumab combined with erlotinib was 1 452 243.01 yuan/QALY， which was more than 3 times China’s per capita GDP in 2023 （268 074 yuan/QALY） as the WTP threshold， indicating that bevacizumab combined with erlotinib was not cost-effective. The results of single factor sensitivity analysis showed that the cost of bevacizumab， the utility value of progression-free survival and progressed disease status had a great influence on the results. The results of probability sensitivity analysis showed that when the WTP threshold was 1 740 000 yuan/QALY， the probability of cost-effective of bevacizumab combined with erlotinib plan was 50%.

CONCLUSIONS

Compared with erlotinib alone， bevacizumab combined with erlotinib is not cost-effective in the first-line treatment of advanced

EGFR

mutant non-squamous NSCLC， when using 3 times China’s per capita GDP in 2023 as the WTP threshold.

关键词

贝伐珠单抗厄洛替尼动态Markov模型成本-效用分析表皮生长因子受体非鳞状非小细胞肺癌药物经济学评价

Keywords

erlotinibdynamic Markov modelcost-utility analysisepithelial growth factor receptornon-squamous non-small cell lung cancerpharmacoeconomic evaluation

references

SUNG H，FERLAY J，SIEGEL R L，et al. Global cancer statistics 2020：GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin，2021，71（3）：209-249.

RUI M J，FEI Z Y，WANG Y C，et al. Cost-effectiveness analysis of sintilimab + chemotherapy versus camrelizumab + chemotherapy for the treatment of first-line locally advanced or metastatic nonsquamous NSCLC in China[J]. J Med Econ，2022，25（1）：618-629.

LAI-KWON J，TIU C，PAL A，et al. Moving beyond epidermal growth factor receptor resistance in metastatic non-small cell lung cancer：a drug development perspective[J]. Crit Rev Oncol Hematol，2021，159：103225.

李旺珍，蔡永广. EGFR-TKI在EGFR突变非小细胞肺癌治疗中的应用现状及进展[J]. 临床医学研究与实践，2022，7（7）：187-191.

LI W Z，CAI Y G. Application status and progress of EGFR-TKI in the treatment of EGFR-mutant non-small cell lung cancer[J]. Clin Res Pract，2022，7（7）：187-191.

PICCIRILLO M C，BONANNO L，GARASSINO M C， et al. Addition of bevacizumab to erlotinib as first-line treatment of patients with EGFR-mutated advanced nonsquamous NSCLC：the BEVERLY multicenter rando- mized phase 3 trial[J]. J Thorac Oncol，2022，17（9）：1086-1097.

夏宇，陈英耀，杨毅. 晚期非小细胞肺癌间接经济负担及其影响因素分析[J]. 中国卫生经济，2023，42（8）：70-73，77.

XIA Y，CHEN Y Y，YANG Y. Indirect economic burden and its influencing factors of patients with advanced non-small cell lung cancer[J]. Chin Health Econ，2023，42（8）：70-73，77.

刘国恩. 中国药物经济学评价指南2020[M]. 北京：中国市场出版社，2020：36-46.

Liu G N. Chinese Pharmacoeconomic Evaluation Guidelines 2020 [M]. Beijing：China Market Publishing House，2020：36-46.

石丰豪，商叶，芮明军，等. R语言survHE程序包在卫生经济学评价中的应用[J]. 中国卫生经济，2020，39（9）：9-14.

SHI F H，SHANG Y，RUI M J，et al. Application of survHE package of R for health economic evaluation[J]. Chin Health Econ，2020，39（9）：9-14.

周挺，马爱霞，付露阳. 药物经济学评价Markov模型中转移概率计算的探讨[J]. 中国卫生经济，2017，36（12）：40-42.

ZHOU T，MA A X，FU L Y. Discusion on the calculation of Markov model transition probability in pharmacoeconomics evaluation[J]. Chin Health Econ，2017，36（12）：40-42.

丁樱，王旋辉，宫春博. 帕博利珠单抗联合化疗方案一线治疗晚期或不可切除胆道恶性肿瘤的成本-效用分析[J]. 中国药房，2023，34（23）：2891-2895.

DING Y，WANG X H，GONG C B. Cost-utility analysis of pembrolizumab combined with chemotherapy in the first-line treatment of advanced or unresectable biliary tract carcinoma[J]. China Pharm，2023，34（23）：2891-2895.

SHU Y M，ZHANG Q L，HE X C，et al. Cost-effectiveness analysis of gefitinib plus chemotherapy versus gefitinib alone for advanced non-small-cell lung cancer with EGFR mutations in China[J]. Cancer Manag Res，2021，13：8297-8306.

LI W Q，LI L Y，CHAI J，et al. Cost-effectiveness analysis of first-line treatments for advanced epidermal growth factor receptor-mutant non-small cell lung cancer patients[J]. Cancer Med，2021，10（6）：1964-1974.

陈昭燕，田方圆，徐珽. 贝伐珠单抗联合标准化疗方案治疗复发性宫颈癌患者的成本-效果分析[J]. 中国现代应用药学，2020，37（10）：1208-1213.

CHEN Z Y，TIAN F Y，XU T. Cost-effectiveness analysis of bevacizumab combined with standard chemotherapy in patients with recurrent cervical cancer[J]. Chin J Mod Appl Pharm，2020，37（10）：1208-1213.

CAI H F，ZHANG L F，LI N，et al. Lenvatinib versus sorafenib for unresectable hepatocellular carcinoma：a cost-effectiveness analysis[J]. J Comp Eff Res，2020，9（8）：553-562.

CHEN Y Z，WEN S D，WU Y，et al. Efficacy and safety of first-generation epidermal growth factor receptor （EGFR） tyrosine kinase inhibitors （TKIs） combined with chemotherapy or antiangiogenic therapy as first-line treatment in patients with EGFR-mutant non-small cell lung cancer：a systematic review and meta-analysis[J]. Crit Rev Oncol Hematol，2021，163：103393.

SUN R Z，HOU Z S，ZHANG Y K，et al. Drug resistance mechanisms and progress in the treatment of EGFR-mutated lung adenocarcinoma[J]. Oncol Lett，2022，24（5）：408.

CHEN J A，RIESS J W. Advances in targeting acquired resistance mechanisms to epidermal growth factor receptor tyrosine kinase inhibitors[J]. J Thorac Dis，2020，12（5）：2859-2876.

LE X N，NILSSON M，GOLDMAN J，et al. Dual EGFR-VEGF pathway inhibition：a promising strategy for patients with EGFR-mutant NSCLC[J]. J Thorac Oncol，2021，16（2）：205-215.

SAITO H，FUKUHARA T，FURUYA N，et al. Erlotinib plus bevacizumab versus erlotinib alone in patients with EGFR-positive advanced non-squamous non-small-cell lung cancer （NEJ026）：interim analysis of an open-label，randomised，multicentre，phase 3 trial[J]. Lancet Oncol，2019，20（5）：625-635.

ROSELL R，DAFNI U，FELIP E，et al. Erlotinib and bevacizumab in patients with advanced non-small-cell lung cancer and activating EGFR mutations （BELIEF）：an international，multicentre，single-arm，phase 2 trial[J]. Lancet Respir Med，2017，5（5）：435-444.

LI X Y，LI W C，HOU L P. A trial-based cost-effectiveness analysis of bevacizumab and chemotherapy versus chemotherapy alone for advanced nonsquamous non-small-cell lung cancer in China[J]. Value Health Reg Issues，2019，18：1-7.

RUI M J，LI H C. Cost-effectiveness of osimertinib vs docetaxel-bevacizumab in third-line treatment in EGFR T790M resistance mutation advanced non-small cell lung cancer in China[J]. Clin Ther，2020，42（11）：2159-2170.e6.

PARODY-RÚA E，GUEVARA-CUELLAR C A. Cost-effectiveness of the addition of bevacizumab to first-line chemotherapy with carboplatin and paclitaxel in patients with non-small cell lung cancer[J]. Value Health Reg Issues，2020，23：93-98.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Systematic review of pharmacoeconomic evaluation on PCSK9 inhibitors for the prevention of cardiovascular disease in patients with hypercholesterolemia

Cost-utility analysis of pembrolizumab combined with chemotherapy in the first-line treatment of advanced or unresectable biliary tract carcinoma

Research on merging methods and influencing factors of health state disutility values estimation ：taking diarrhea caused by antitumor drugs as an example

Pharmacoeconomic evaluation of Qili qiangxin capsule in the treatment of chronic heart failure

Related Author

FU Yuanyuan

ZHOU Jiancheng

ZOU Ying

WANG Luying

CHEN Pingyu

WANG Yongqing

DING Ying

WANG Xuanhui

Related Institution

Dept. of Pharmacy， the First Affiliated Hospital of Nanjing Medical University

School of Pharmacy， Nanjing Medical University

School of International Pharmaceutical Business， China Pharmaceutical University

School of Pharmacy， Shandong University of Traditional Chinese Medicine

Address：8th Floor, Sihuan Building, No. 129 Daping Main Street, Yuzhong District, Chongqing, China Postal code：400042
Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号公网安备50010302001817
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰

Cost-utility analysis of bevacizumab combined with erlotinib in the first-line treatment of advanced EGFR mutant non-squamous NSCLC

DOI：10.6039/j.issn.1001-0408.2024.11.13

摘要

Abstract

关键词

Keywords

references