伊沙佐米治疗复发/难治性骨髓瘤的成本-效用分析

Cost-utility Analysis of Ixazomib in the Treatment of Relapsed/Refractory Multiple Myeloma

目的探讨伊沙佐米在中国治疗复发和(或)难治性多发性骨髓瘤(MM)的经济学以及具有成本-效用优势的价格范围。方法基于实际开展的临床试验,运用药物经济学方法,考察试验组(伊沙佐米+来那度胺+地塞米松)和对照组(来那度胺+地塞米松)治疗多发性骨髓瘤5年的直接成本、质量调整生命年(QALYs)、增量成本-效用比(ICUR),进行单因素敏感性分析和概率敏感性分析。假定试验组有经济学,倒推对应的伊沙佐米的价格。结果模型运行5年,试验组和对照组的人均治疗成本分别为64253美元和38179美元,人均获得生命年分别为1.80年和1.37年,人均获得QALYs分别为1.2和0.91。与对照组比较,试验组的ICUR为90 964美元/QALY,高于2018年中国3倍人均国内生产总值(GDP)的28 257.2美元,因此不具有成本-效用优势。当ICUR为3倍人均GDP时,对应的价格为负值。结论试验组治疗复发/难治性MM,无论何时都不具有经济学。

Objective To study the economy of ixazomib in the treatment of relapsed/refractory multiple myeloma(MM) and the price range with cost-utility advantage in China. Methods Based on the actual clinical experiments, pharmacoeconomic methods were used to investigate the annual direct cost of treatment of multiple myeloma in the experimental group(Isazomib + lenalidomide + dexamethasone) and the control group(lenalidomide + dexamethasone) in 5 years, quality adjusted life years(QALYs), incremental cost-utility ratio(ICUR), single-factor sensitivity analysis and probability sensitivity analysis. Assuming that the experimental group had economics, the corresponding price of Ishazomi was reversed. Results Running the model for 5 years, the costs of treatment per capita in the experimental group and the control group were 64 253 US dollars and 38 179 US dollars, and the life years(LYs) per capita were 1.80 and 1.37 years, and the QALYs per capita were 1.2 and 0.91 respectively. Compared with the control group, the ICUR of the experimental group was $90 964/QALY, which was higher than 3 times of China’s per capita GDP of $28 257.2 in 2018, so it had no cost-utility advantage. When the ICUR was 3 times of GDP per capita, the corresponding price of ixazomib was negative. Conclusion The treatment of relapsed/refractory MM in the trial group is not economical at any time.