斯鲁利单抗联合化疗一线治疗PD-L1(CPS≥1)局部晚期或转移性食管鳞状细胞癌的成本-效用分析

Cost-utility analysis of serplulimab combined with chemotherapy in the first-line treatment of PD-L1(CPS≥1)locally advanced or metastatic esophageal squamous cell carcinoma

目的:从中国卫生体系角度评价斯鲁利单抗联合化疗对比单独化疗一线治疗PD-L1综合阳性得分(CPS)≥1局部晚期或转移性食管鳞状细胞癌的经济性。方法:基于ASTRUM-007的研究,建立三状态的分区生存模型,进行成本-效用分析,循环周期为2周,模拟时限为患者终身,贴现率为5%。以增量成本-效果比(ICER)为指标评价斯鲁利单抗联合化疗对比单独化疗的经济性,并对结果进行敏感性分析。结果:成本-效用分析结果显示,斯鲁利单抗联合化疗对比单独化疗的ICER为914665.82元/QALY,高于2022年中国3倍人均GDP。敏感性分析结果显示,对结果影响较大的因素分别是斯鲁利单抗成本、PFS状态效用值、PD状态效用值和贴现率;在意愿支付(WTP)阈值为2022年中国3倍人均GDP的情况下,斯鲁利单抗联合化疗具有经济性的概率为0。结论:以2022年中国3倍人均GDP作为WTP阈值,斯鲁利单抗联合化疗对比单独化疗一线治疗PD-L1(CPS≥1)局部晚期或转移性食管鳞状细胞癌不具有经济性。

OBJECTIVE To evaluate the economics of serplulimab combined with chemotherapy versus chemotherapy alone in the first-line treatment of locally advanced or metastatic esophageal squamous cell carcinoma with PD-L1 combined positive score(CPS)≥1 from the perspective of China’s health system.METHODS Based on the ASTRUM-007 study,a three-state partitioned survival model was developed for cost-utility analysis,and the cycle was 2 weeks,the simulated time limit was patient lifetime,and the discount rate was 5%.The incremental cost-effectiveness ratio(ICER)was used as an indicator to evaluate the economics of serplulimab combined with chemotherapy compared with chemotherapy alone,and sensitivity analysis was per⁃formed on the results.RESULTS The results of cost-utility analysis showed that the ICER of serplulimab combined with chemo⁃therapy compared with chemotherapy alone was 914665.82 yuan/QALY,which was higher than 3-fold per capita GDP in China in 2022.The results of sensitivity analysis showed that the factors significantly affecting the results were the cost of serplulimab,the PFS state utility value,PD state utility value and discount rate;in the willingness to pay(WTP)threshold was three times China’s per capita GDP in 2022,the economic probability of serplulimab combined with chemotherapy was 0.CONCLUSION Using 3 times China’s per capita GDP in 2022 as the WTP threshold,serplulimab combined with chemotherapy is not economical compared with chemotherapy alone in the first-line treatment of PD-L1(CPS≥1)locally advanced or metastatic esophageal squamous cell carcinoma.