度伐利尤单抗联合化疗一线治疗广泛期小细胞肺癌的成本效果分析

Cost-effectiveness analysis of durvalumab combined with chemotherapy in first-line treatment of extensive stage small-cell lung cancer

目的评价度伐利尤单抗联合化疗对比单纯化疗一线治疗广泛期小细胞肺癌的成本效果。方法建立三种健康状态的分区生存模型模拟疾病转归,模型中的临床数据主要基于CASPIAN临床试验,仅纳入直接医疗成本,效用值参考已发表的文献,同时对度伐利尤单抗的使用周期和价格进行情景分析。通过Treeage软件计算两个方案各自的总成本和总产出,以增量成本效果比(ICER)作为评价指标,并对关键参数进行敏感性分析。结果与单纯化疗方案(依托泊苷联合铂类)相比,在慈善援助且度伐利尤单抗使用10个周期的情境下度伐利尤单抗联合化疗的ICER为811310元·QALY^(-1),在无慈善援助度伐利尤单抗维持治疗直至进展的情境下ICER为1761502元·QALY^(-1)。敏感性分析显示效用值和度伐利尤单抗价格是主要的影响参数,模型结果稳定。结论度伐利尤单抗联合化疗对比单纯化疗一线治疗广泛期小细胞肺癌不具有成本效果优势。

AIM To evaluate the cost-effectiveness of durvalumab combined with chemotherapy versus chemotherapy alone in the first-line treatment of extensive stage small cell lung cancer.METHODS A three health state partition survival model was established to simulate the outcome of disease.The clinical data in the model were mainly based on CASPIAN clinical trials,only the direct medical costs were included,and the utility value was referred to the published literature.The course and price of durvalumab were analyzed by scenario analysis.The total cost and total output of the two strategies were simulated by Treeage software,and the incremental cost-effectiveness ratio(ICER)was used as the evaluation index.The sensitivity of key parameters was analyzed.RESULTS Compared with pure chemotherapy(etoposide plus platinum chemotherapy),the ICER of durvalumab combined with chemotherapy was 811310 yuan·QALY-1 under the situation of charity assistance and durvalumab used for 10 cycles,and 1761502 yuan·QALY-1 in the environment of no charity assistance.Sensitivity analysis showed that the utility and the cost of durvalumab were the main influence parameter,but the results of the model were still stable.CONCLUSION Durvalumab combined with chemotherapy is not cost-effective compared with chemotherapy alone in the first-line treatment of extensive stage small cell lung cancer.