替吉奥治疗局部晚期或转移性非小细胞肺癌药物经济学评价

Pharmacoeconomic Evaluation of S-1 in the Treatment of Locally Advanced or Metastatic Non-Small Cell Lung Cancer

目的评价替吉奥治疗局部晚期或转移性非小细胞肺癌(NSCLC)的经济性。方法纳入一项开放、随机、非劣性、多中心Ⅲ期临床试验,构建马尔科夫(Markov)模型模拟疾病进程,得到不同治疗方案的增量成本-效果比(ICER),并进行敏感性分析。结果与多西他赛相比,替吉奥治疗局部晚期或转移性NSCLC的人均累积成本更高(21717.00元比19336.19元)、更有效(0.355比0.353);替吉奥相对于多西他赛的ICER为1190405元/质量调整生命年,远大于3倍人均国内生产总值,无经济学优势;敏感性分析结果显示,疾病转移概率对结果的影响较大,其次是替吉奥的药品价格;且替吉奥保持疾病无进展状态和疾病进展状态时对结果的影响大于多西他赛疾病转移状态变化产生的影响;当替吉奥疾病无进展转移至疾病无进展的概率或疾病进展转移至疾病进展的概率逐渐升高,且药品成本逐渐降低时,ICER有逐渐降低趋势。结论与多西他赛相比,替吉奥治疗局部晚期或转移性NSCLC不具经济性。

Objective To evaluate the economy of Tegafur Gimeracil Oteracil Potassium(S-1)in the treatment of locally advanced or metastatic non-small cell lung cancer(NSCLC).Methods An open,randomized,non-inferior and multicenter phaseⅢclinical trial[An East Asia S-1 Trial in Lung Cancer(EAST-LC)]was included.Markov model was constructed to simulate the disease progression,the incremental cost-effectiveness ratio(ICER)of different treatment schemes was obtained,and the sensitivity was analyzed.Results Compared with docetaxel,S-1 in the treatment of locally advanced or metastatic NSCLC had higher per capita cumulative cost(21717.00 CNY vs.19336.19 CNY)and it was more effective(0.355 vs.0.353).The ICER of S-1 to docetaxel was 1190405 CNY per quality-adjusted life years(QALYs),far more than three times the per capita GDP,without economic advantage.The sensitivity analysis showed that the transition probability of disease′s progression had a great impact on the ICER,followed by the price of S-1.The effect of S-1 on the ICER when disease maintaining the state of progression-free survival(PFS)and progressive disease(PD)was greater than that of docetaxel when changes occurred in disease′s progression.ICER tended to decrease gradually when the probability of disease′s progression transferring from PFS to PFS with S-1 or the probability of disease′s progression transferring from PD to PD with S-1 gradually increased while the drug cost gradually decreased.Conclusion Compared with docetaxel,S-1 is not economical in the treatment of locally advanced or metastatic NSCLC.