培美曲塞在非小细胞肺癌患者中维持治疗的成本效果分析

Cost effectiveness analysis of pemetrexed maintenance in patients with advanced nonsquamouscell lung cancer

目的:从中国医疗卫生角度出发,评价培美曲塞的成本效果。方法:根据晚期肺癌患者疾病发展的自然史建立Markov模型,将模型分为无进展(progressive free survival,PFS)状态、进展(progressive survival,PS)状态和死亡(dead)状态;用TreeAge Pro Suite 2009软件计算增量成本效果比(incremental cost effectiveness ratio,ICER),并对结果进行敏感度分析。结果:培美曲塞+最佳支持治疗(best support care,BSC)与BSC相比,ICER为431 421.54元/质量调整生命年(quality adjusted life years,QALYs);一元敏感度分析结果显示,BSC成本在PFS状态和PS状态的成本比值对结果的影响最大,其次是PFS状态的效用值及培美曲塞的成本,其他参数对模型影响较小。概率敏感度分析显示,WTP(willingness to pay)阈值为89 976元(3-GDP)时,培美曲塞具有成本效果的概率仅为15.4%。结论:研究证明,晚期非小细胞肺癌非鳞癌患者维持治疗+BSC与BSC比较不具有成本效果,敏感度分析证明模型基本稳定。

OBJECTIVE To evaluate cost effectiveness of pemetrexed maintenance in patients with advanced nonsquamouscell lung cancer from the perspective of Chinese health care system.METHODS A Markov model was built based on natural history of advanced lung cancer,which was composed of three mutually exclusive health states：progressive free survival（PFS）,progressive survival（PS）and dead.Models were rolled back on Tree Age Pro Suite 2009.One-way sensitivity analysis and probability analysis were performed to test robustness of results.RESULTS According to models,incremental cost effectiveness ratio of pemetrexed plus best support care（BSC）compared with BSC was 431 421.54 yuan per quality-adjusted lifeyear gained.On one-way sensitivity analysis,proportion of BSC costs in PFS versus PS had a remarkable influence,followed by utility in PFS and cost of pemetrexed.On probability analysis,probability of pemetrexed being cost effectiveness was only15.4% at a willingness to pay of 89 976 yuan.CONCLUSION Findings from present analysis suggest that pemetrexed plus BSC might not be cost-effective in advanced nonsquamous-cell lung cancer from the perspective of Chinese health care system.Sensitivity analysis provides evidences for robustness of models.