特瑞普利单抗联合化疗一线治疗晚期食管鳞状细胞癌的成本-效果分析

Cost-effectiveness Analysis of Toripalimab Plus Chemotherapy as First Line Treatment for Advanced Esophageal Squamous Cell Carcinoma

目的 从中国卫生体系角度评估特瑞普利单抗与安慰剂联合化疗作为晚期食管鳞状细胞癌患者的一线治疗方案的成本效果。方法 通过构建3种健康状态的分区生存模型,分析了2种方案的成本-效果。有关成本、健康效用和临床结果等参数信息来自相关网站、已发表的文献和JUPITER-06 III期随机临床试验。采用质量调整生命年(quality-adjusted life year,QALY)为产出指标衡量增量成本效果比(incremental cost-effectiveness ratio,ICERs),并选择中国人均国内生产总值的3倍作为意愿支付(willingness to pay,WTP)阈值来判断是否经济。通过单因素敏感性分析、概率敏感性分析评估模型的稳健性,还进行了额外情境分析评价特瑞普利单抗联合化疗对比信迪利单抗联合化疗的经济性。结果 基础案例中,在晚期食管鳞状细胞癌患者中,特瑞普利单抗联合化疗相比安慰剂联合化疗可以改善生存获益并增加成本,ICER为38 083元/QALY。单因素敏感性分析表明,每周期特瑞普利单抗成本是影响ICER的关键因素,概率敏感性分析表明,在WTP阈值为每QALY为257 094元的情况下,与安慰剂联合化疗相比,特瑞普利单抗联合化疗具有成本效果的概率为100%。情境分析结果显示特瑞普利单抗联合化疗相比信迪利单抗联合化疗为相对优势方案。结论 从中国卫生体系的角度来看,特瑞普利单抗联合化疗作为晚期食管鳞状细胞癌患者一线治疗是一种具有成本效果的选择。

OBJECTIVE To evaluate the cost-effectiveness of combination chemotherapy with toripalimab and placebo as a first-line treatment for advanced esophageal squamous cell carcinoma patients from the perspective of the Chinese health system.METHODS A partitioned survival model with three health states was constructed to analyze the cost-effectiveness of the two schemes.Information on parameters such as cost,health utility and clinical outcome were derived from related websites,published literature and phase III randomized clinical trials of JUPITER-06.The quality-adjusted life year(QALY)was the output index evaluating incremental cost-effectiveness ratio(ICERs),and three times of the per capita gross domestic product in China was selected as the willingness to pay(WTP)threshold to judge whether it was economic.One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model.An additional situational analysis was performed to evaluate the economics of toripalimab plus chemotherapy versus sintilimab plus chemotherapy.RESULTS In the basic case,toripalimab plus chemotherapy could improve health outcomes with an augmentation of cost compared with placebo plus chemotherapy in first-line advanced esophageal squamous cell carcinoma patients,resulting the ICERs of¥38083/QALY.One-way and sensitivity analysis showed that the costs of toripalimab per cycle was the crucial factor in affecting the ICER,and probabilistic sensitivity analyses demonstrated toripalimab plus chemotherapy was 100%cost-effective compared with placebo plus chemotherapy at a WTP threshold of¥257094 per QALY.The results of situation analysis showed that toripalimab plus chemotherapy was a relatively advantageous regimen compared with sintilimab plus chemotherapy.CONCLUSION From the perspective of Chinese healthcare perspective,first-line treatment with toripalimab plus chemotherapy is a cost-effective option for patients with advanced esophageal squamous cell carcinoma.