替雷利珠单抗二线治疗晚期或转移性食管鳞状细胞癌的成本-效用分析

刘世贤; 李顺平; 窦蕾; 王凯旋; 史钊; 王瑞雪; 朱晓红; 宋泽华

doi:10.6039/j.issn.1001-0408.2022.18.15

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替雷利珠单抗二线治疗晚期或转移性食管鳞状细胞癌的成本-效用分析

药物经济学 | 更新时间：2023-02-22

- 替雷利珠单抗二线治疗晚期或转移性食管鳞状细胞癌的成本-效用分析
- Cost-utility analysis of tislelizumab in the second-line treatment of advanced or metastatic esophageal squamous cell carcinoma
- 中国药房 2022年33卷第18期页码：2250-2255
- 作者机构：
  
  1.山东大学齐鲁医学院公共卫生学院卫生管理与政策研究中心，济南　250012
  2.国家卫生健康委员会卫生经济与政策研究重点实验室（山东大学），济南　250012
  3.山东大学健康偏好研究中心，济南　250012
- 作者简介：
  
  硕士研究生。研究方向：肿瘤药物经济学、卫生技术评估。E-mail：17862971780@163.com
  教授，博士生导师，博士。研究方向：健康偏好与健康结果测量、罕见病诊疗与保障、卫生技术评估。电话：0531-88380161。E-mail：lishunping@sdu.edu.cn
- 基金信息：
  
  Δ 基金项目美国中华医学基金会项目(CMB14-195)
- DOI：10.6039/j.issn.1001-0408.2022.18.15
  中图分类号： R956
- 纸质出版日期：2022-09-30，
  
  收稿日期：2022-05-04，
  
  修回日期：2022-08-09，
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刘世贤,李顺平,窦蕾等.替雷利珠单抗二线治疗晚期或转移性食管鳞状细胞癌的成本-效用分析 ^Δ[J].中国药房,2022,33(18):2250-2255.

LIU Shixian,LI Shunping,DOU Lei,et al.Cost-utility analysis of tislelizumab in the second-line treatment of advanced or metastatic esophageal squamous cell carcinoma[J].ZHONGGUO YAOFANG,2022,33(18):2250-2255.
刘世贤,李顺平,窦蕾等.替雷利珠单抗二线治疗晚期或转移性食管鳞状细胞癌的成本-效用分析 ^Δ[J].中国药房,2022,33(18):2250-2255. DOI： 10.6039/j.issn.1001-0408.2022.18.15.

LIU Shixian,LI Shunping,DOU Lei,et al.Cost-utility analysis of tislelizumab in the second-line treatment of advanced or metastatic esophageal squamous cell carcinoma[J].ZHONGGUO YAOFANG,2022,33(18):2250-2255. DOI： 10.6039/j.issn.1001-0408.2022.18.15.

摘要

目的

评估替雷利珠单抗对比化疗二线治疗中国晚期或转移性食管鳞状细胞癌（ESCC）患者的经济性。

方法

从中国卫生体系角度构建三状态Markov模型，评价替雷利珠单抗对比化疗在晚期或转移性ESCC患者总人群及程序性死亡受体1（PD-L1）阳性人群二线治疗中的经济性；模型周期为1个月，模拟时限为10年，成本和效果的贴现率为5%。采用单因素敏感性分析、概率敏感性分析以及情境分析验证基础分析结果的稳健性。

结果

基础分析结果表明，与化疗相比，替雷利珠单抗二线治疗中国晚期或转移性ESCC及PD-L1阳性患者的增量成本-效果比（ICER）分别为26 864.01元/QALY和37 510.07元/QALY，远低于1倍我国2021年人均国内生产总值（GDP，80 976元）。情境分析结果显示，无论化疗采用何种方案（紫杉醇、多西他赛或伊立替康），ICER均低于1倍我国2021年人均GDP；随着模拟时限的延长，替雷利珠单抗方案的ICER逐渐降低，降幅逐渐减小，但均低于1倍我国2021年人均GDP。单因素敏感性分析结果显示，对ICER影响最大的3个参数分别为替雷利珠单抗组无进展生存期、替雷利珠单抗价格以及替雷利珠单抗组接受后续治疗的患者比例。概率敏感性分析结果表明，以3倍我国2021年人均GDP为意愿支付阈值时，替雷利珠单抗在晚期或转移性ESCC总人群和PD-L1阳性患者中具有经济性的概率分别为99.09%和99.94%。

结论

替雷利珠单抗对比化疗二线治疗晚期或转移性ESCC患者具有经济学优势。

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of tislelizumab in the second-line treatment of advanced or metastatic esophageal squamous cell carcinoma （ESCC） in China.

METHODS

A three-state Markov model was constructed to assess the cost-effectiveness of tislelizumab versus chemotherapy in the second-line treatment of advanced or metastatic ESCC and programmed death receptor 1 （PD-L1） positive patients. The cycle length of the model was 1 month， and the time horizon of the model was set as 10 years. The discount rate of cost and utility was 5%. One-way sensitivity analysis， probability sensitivity analysis and scenario analysis were used to verify the robustness of the base-case analysis results.

RESULTS

The results of the base-case analysis showed that compared with chemotherapy， the incremental cost-effectiveness ratio （ICER） of tislelizumab in the second-line treatment of advanced or metastatic ESCC and PD-L1-positive patients were 26 864.01 yuan/QALY and 37 510.07 yuan/QALY， respectively， which was much lower than 1 time per capita gross domestic product （GDP） in 2021 （80 976 yuan）. Results of scenario analysis showed that the ICER was less than 1 times per capita GDP， regardless of the chemotherapy regimens （paclitaxel， docetaxel or irinotecan） used. With the extension of the simulation time limit， the ICER of tirelizumab regimen gradually decreased， and the reduction rate gradually decreased， but they were all less than 1 time China’s per capita GDP in 2021. The results of the one-way sensitivity analysis showed that the 3 parameters with the most significant impact on the ICER were progression-free survival of tislelizumab group， price of tislelizumab， and the proportion of patients receiving follow-up treatment in the tislelizumab group. The results of the probability sensitivity analysis showed that the probability of tislelizumab with cost-effectiveness in the treatment of advanced or metastatic ESCC patients and PD-L1-positive patients were 99.09% and 99.94%， respectively， when using 3 times per capita GDP as the willingness-to-pay threshold.

CONCLUSIONS

Tislelizumab has economic advantages over chemotherapy alone in the second-line treatment of advanced or metastatic ESCC patients.

关键词

替雷利珠单抗晚期或转移性食管鳞状细胞癌成本-效用分析Markov模型

Keywords

advanced or metastatic esophageal squamous cell carcinomacost-utility analysisMarkov model

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