阿比特龙一线治疗转移性去势抵抗性前列腺癌的成本-效用分析

Cost-Utility Analysis on Abiraterone in First-Line Treatment of Metastatic Castration-Resistant Prostate Cancer

目的:从我国卫生体系角度,评估阿比特龙一线治疗既往未接受化疗的转移性去势抵抗性前列腺癌(mCRPC)患者的经济性。方法:采用分区生存模型预测mCRPC患者终身疾病进程,其中疗效和安全性数据均来自COU-AA-302研究,成本数据来自本地数据。结果以成本、质量调整生命年(QALY)、增量成本-效果比(ICER)表示。对模型的不确定性进行单因素和概率性敏感性分析。结果:目前,对于既往未接受化疗的mCRPC患者,阿比特龙组相对于雄激素剥夺治疗(ADT)组可多获得0.26个QALY,ICER为587430元/QALY。结论:相较于ADT方案,阿比特龙可以显著延长mCRPC患者的生命年,并改善患者的生活质量,但相应的医疗成本也会增加。在意愿支付值为3倍我国人均国内生产总值的情况下,阿比特龙治疗mCRPC不具有经济优势。

OBJECTIVE:From the perspective of health system in China,to evaluate the economical efficiency of abiraterone in first-line treatment of metastatic castration-resistant prostate cancer(mCRPC)without previous chemotherapy treatment.METHODS:The partitioned survival model was used to predict lifetime disease course of mCRPC,efficacy and safety data were derived from COU-AA-302 trial.Cost data were came from local data.Results were expressed in terms of cost,quality-adjusted life year(QALY),and incremental cost-effectiveness ratio(ICER).The uncertainty of the model was analyzed by single factor and probabilistic sensitivity.RESULTS:At present,for mCRPC patients who had not previously received chemotherapy,0.26 more QALYs were obtained in the abiraterone group than in androgen deprivation therapy(ADT)group,with an ICER of 587430 yuan/QALY.CONCLUSIONS:Compared with ADT regimens,abiraterone can significantly extend the life years of patients with mCRPC and improve the quality of life,yet the corresponding medical costs will increase.Abiraterone does not have an economic advantage in the treatment of mCRPC at a willingness-to-pay of three times China’s GDP per capita.