紫杉醇白蛋白结合型联合卡铂一线治疗晚期非小细胞肺癌合并肾功能损伤患者的成本效果分析

Cost-effectiveness analysis of nab-paclitaxel in combination with carboplatin as first-line therapy in patients with advanced none small-cell lung cancer and renal impairment

目的:从我国医疗卫生系统角度评价紫杉醇白蛋白结合型联合卡铂(nab-P/C)与紫杉醇注射液联合卡铂(sb-P/C)治疗晚期非小细胞肺癌合并肾功能损伤患者的经济性。方法:基于已发表的一项高质量的Ⅲ期临床随机对照试验,根据疾病发展过程建立Markov模型,将NSCLC患者的疾病发展过程归为无进展生存状态、疾病进展状态和死亡状态,对nab-P/C方案与sb-P/C方案进行成本-效果分析,并采用单因素敏感度分析和概率敏感度分析对结果的不确定性进行评价。结果:根据Markov模型分析结果,当合并中度肾功能损伤(CrCl≤50 mL·min-1)时,nab-P/C方案对比sb-P/C方案的ICER值为181893.70元/QALYs;当合并轻度肾功能损伤(50<CrCl≤80mL·min-1)时,ICER值为177993.23元/QALYs,均低于我国居民意愿支付阈值(212676元/QALYs),具有成本效果。单因素敏感性分析结果提示,nab-P/C方案二线药物治疗费用对成本-效果分析结果的影响最大,其次是sb-P/C方案二线药物治疗费用;概率敏感性分析结果提示,随着我国人均国内生产总值的增长,nab-P/C方案具有成本-效果的概率呈逐渐升高的趋势。结论:与sb-P/C方案相比,nab-P/C方案治疗合并肾损伤的晚期或复发性鳞状细胞NSCLC具成本-效果优势。

OBJECTIVE To evaluate the economics of nab-paclitaxel combined with carboplatin(nab-P/C) and solvent-based paclitaxel combined with carboplatin(sb-P/C) under different renal function states.METHODS Based on a published high-quality phase Ⅲ clinical randomized controlled trial,a Markov model was established according to the disease development process,including three mutually exclusive health states:progression-free survival state,disease progression state,and death.Sensitivity analysis was conducted to evaluate the uncertainty of the results.RESULTS According to the results of Markov model analysis,when combined with moderate renal impairment(CrCl ≤ 50 mL·min-1),the ICER of nab-P/C regimen was 181 893.70 yuan/QALYs compared with sb-P/C regimen;when combined with mild renal impairment(50<CrCl ≤ 80 mL·min-1),the ICER of 177 993.23 yuan/QALYs was lower than the willingness to pay threshold of Chinese residents(212 676 yuan/QALYs),with cost-effectiveness.The results of univariate sensitivity analysis suggested that the cost of second-line drug treatment with nab-P/C regimen had the greatest impact on the results of cost-effectiveness analysis,followed by the cost of second-line drug treatment with sb-P/C regimen;the results of probability sensitivity analysis suggested that the probability of cost-effectiveness of nab-P/C regimen showed a gradually increasing trend with the growth of gross domestic product per capita in China.CONCLUSION Compared with the sb-P/C regimen,the nab-P/C regimen has a cost-effectiveness advantage in the treatment of NSCLC and renal impairment.