帕博利珠单抗联合化疗一线治疗晚期三阴性乳腺癌的成本-效果分析

Combination of pembrolizumab and chemotherapy as first-line treatment in advanced triple-negative breast cancer:a cost-effectiveness analysis

本文旨在从中国卫生体系角度评价帕博利珠单抗联合化疗治疗晚期TNBC的成本-效果。建立具有三种健康状态的Markov模型,该模型的模拟时限为10年,循环周期为21天。通过单因素敏感性分析和概率敏感性分析来验证模型的稳健性,进行情景分析来探讨中国患者援助计划(PAP)下帕博利珠单联合化疗治疗晚期TNBC的经济性。基础分析结果表明,帕博利珠单抗联合化疗可多获得0.67 QALYs,增量成本为$77096.78,ICER为115896.30$/QALY。单因素敏感性分析结果显示,帕博利珠单抗成本对结果的影响最大。概率敏感性分析结果显示,在中国的意愿支付阈值下(33782.23$/QALY),帕博利珠单抗联合化疗具有经济性的概率为0。从中国卫生体系角度来看,与安慰剂联合化疗相比,帕博利珠单抗联合化疗一线治疗晚期TNBC不具有成本-效果优势。如果考虑帕博利珠单抗纳入PAP,虽仍然不具有经济性,但是ICER更加接近于中国3倍人均GDP。

The purpose of this study was to assess the cost-effectiveness of using pembrolizumab plus chemotherapy for advanced triple-negative breast cancer(TNBC)in the context of China’s healthcare system.To achieve this,we developed a Markov model with three health states,a time horizon of 10 years,and a cycle length of 21 days.Additionally,we conducted one-way sensitivity analyses and probabilistic sensitivity analyses to test the model’s stability.Scenario analyses were also performed to explore the cost-effectiveness of pembrolizumab plus chemotherapy based on the Patient Assistance Program(PAP).The base-case analysis demonstrated that pembrolizumab plus chemotherapy provided an additional 0.67 QALYs,with an incremental cost of$77096.78,resulting in an ICER of$115896.30/QALY.One-way sensitivity analyses revealed that pembrolizumab cost had the greatest impact on the results.In probabilistic sensitivity analyses,pembrolizumab plus chemotherapy was found to be cost-effective in 0%of cases at willingness-to-pay thresholds of$33782.23/QALY.Considering China’s healthcare system,pembrolizumab plus chemotherapy as first-line treatment for advanced TNBC was unlikely to be cost-effective when compared to placebo plus chemotherapy.Even if pembrolizumab was to be included in the PAP,it would still not be considered cost-effective,although the ICER would be much closer to three times China’s GDP per capita($33782.23/QALY).