单用依维莫司和依维莫司联合依西美坦治疗晚期乳腺癌的成本效果分析

Cost-effectiveness Analysis of Everolimus and Everolimus Combined with Exemestane in the Treatment of Advaneed Breast Cancer

目的从中国卫生体系角度出发,评价单用依维莫司和依维莫司联合依西美坦用于治疗晚期乳腺癌的成本效果。方法利用一项Ⅱ期多中心、高质量的BOLERO-6临床试验数据结果,根据Markov模型建立无进展生存、疾病进展、死亡三个状态。通过TreeAgePro 2011软件模拟雌激素受体阳性、人类表皮生长因子受体2阴性晚期乳腺癌患者10年内疾病进展,得出两种治疗方案的增量成本效果比(Incremental cost-effectiveness ratio,ICER),并对模型输出结果进行敏感性分析。结果模型的输出结果表明,依西美坦联合依维莫司较单用依维莫司,二者的ICER值为1621881.4元/质量调整生命年(Quality-adjusted life year,QALY),远高于3倍人均GDP的意愿支付阈值193932元/QALY。并且单因素和概率敏感性分析的结果显示结论可靠。结论在中国卫生体系背景下,单用依维莫司治疗雌激素受体阳性、人类表皮生长因子受体2阴性晚期乳腺癌更具有经济性。

OBJECTIVE To evaluate the cost-effectiveness of everolimus alone and everolimus combined with exemestane for the treatment of advanced breast cancer from the perspective of public medical service payers.METHODS Based on the results of a phase Ⅱ multi-center,high-quality BOLERO-6 clinical trial,three states of progression-free survival,disease progression,and death were established according to the Markov model.Using Tree-AgePro2011 software to simulate estrogen receptor positive and human epidermal growth factor receptor 2 negative advanced breast cancer patients within 10 years of disease progression,the incremental cost-effectiveness ratio(ICER)of the two treatment options was obtained,and perform sensitivity analysis on the model output.RESULTS The results of the model showed that the ICER value of exemestane combined with everolimus was 1621881.4 yuan per quality-adjusted life year(QALY),which was 3 times higher than that of willingness to pay(WTP)of 193932 yuan per QALY.And the results of one-way and probability sensitivity analysis showed that the conclusion was reliable.CONCLUSION Everolimus is more economical for the treatment of estrogen receptor positive and human epidermal growth factor receptor 2 negative advanced breast cancer in the context of Chinese public health.