劳拉替尼与阿来替尼一线治疗间变性淋巴瘤激酶阳性非小细胞肺癌的药物经济学评价

Pharmacoeconomic Evaluation of Lorlatinib and Alectinib in the First-Line Treatment of Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer

目的评价劳拉替尼与阿来替尼一线治疗间变性淋巴瘤激酶(ALK)阳性非小细胞肺癌(NSCLC)的经济性。方法基于2项临床研究CROWN试验和ALEX试验及1项已发表的网状Meta分析结果构建3种状态(疾病进展、无进展生存、死亡)的分区生存模型,以质量调整生命年(QALY)为效果评价指标,计算增量成本-效果比(ICER),并进行单因素敏感性分析和概率敏感性分析,以验证基础分析结果的稳健性。结果分区生存模型基础分析结果显示,劳拉替尼方案的总成本为18607455.74元、效用值为4.05QALYs,阿来替尼方案的总成本为908292.62元、效用值为3.41 QALYs,劳拉替尼ICER为27654942.38元/QALY。单因素敏感性分析结果显示,无进展生存状态和疾病进展状态的效用值和劳拉替尼成本对ICER影响较大。概率敏感性分析结果显示,以2021年我国1~3倍人均国内生产总值(GDP)为意愿支付阈值,劳拉替尼具有经济性的概率为0。结论相较于劳拉替尼,阿来替尼一线治疗ALK阳性晚期NSCLC更具成本-效果优势。

Objective To evaluate the economics of lorlatinib and alectinib in the first-line treatment of anaplastic lymphoma kinase(ALK)-positive non-small cell lung cancer(NSCLC).MethodsBased on the results of two clinical studies including CROWN trial and ALEX trial and a published network Meta-analysis,a partitioned survival model with three status(progressive disease,progression-free survival and death)was constructed with the quality-adjusted life year(QALY)as the effect indicator,the incremental cost-effectiveness ratio(ICER)was calculated,and the one-way sensitivity analysis and the probabilistic sensitivity analysis were conducted to verify the robustness of the results of base-case analysis.ResultsThe results of the base-case analysis of partitioned survival model showed a total cost of CNY 18607455.74,a utility value of 4.05 QALYs for the lorlatinib,and a total cost of CNY 908292.62,a utility value of 3.41 QALYs for alectinib,and the ICER of lorlatinib was CNY27654942.38 per QALY.The results of one-way sensitivity analysis showed that the utility value of progression-free survival status,the utility value of progressive disease status and the cost of lorlatinib had a greater impact on the ICER.The results of the probabilistic sensitivity analysis showed that the probability of lorlatinib being economical was zero with the willingness-to-pay threshold of 1-3 times gross domestic product(GDP)per capita of China in 2021.ConclusionCompared with lorlatinib,alectinib is more cost-effective in the first-line treatment of advanced ALK-positive NSCLC.