帕博利珠单抗对比多西他赛治疗PD-L1低表达晚期非小细胞肺癌的成本-效用分析

Cost-utility analysis of pembrolizumab versus docetaxel for advanced PD-L1 low-expressing non-small cell lung cancer

目的:从中国医疗卫生体系的角度出发,对帕博利珠单抗与多西他赛治疗PD-L1低表达晚期非小细胞肺癌进行经济性评价。方法:该数据来源于Ⅲ期临床试验(KEYNOTE-033),对其进行数据重构,构建分区生存模型进行成本-效用分析,以增量成本-效用比(incremental cost-utility ration,ICUR)作为其分析评价的指标,研究时限为7年,模型周期为21 d;采用单向敏感性分析和概率敏感性分析进行参数的不确定性分析,测试模型结果的稳定性。结果:帕博利珠单抗组较多西他赛组的ICUR值为634893.48元/QALY,高于意愿支付(willingneess to pay,WTP)阈值257094元/QALY。通过单因素敏感性分析结果得出,帕博利珠单抗费用对结果影响较大。通过概率敏感性分析结果得出,当WTP为3倍人均GDP时,多西他赛组更具成本-效用。结论:在我国处于现有经济水平下,帕博利珠单抗对比多西他赛治疗PD-L1低表达晚期非小细胞肺癌,多西他赛组更具有成本-效用的优势。

OBJECTIVE To conduct an economic evaluation of pembrolizumab versus docetaxel for advanced squamous non-small cell lung cancer(NSCLC)with low PD-L1 expression from the perspective of domestic healthcare system.METHODS Raw data of phaseⅢclinical trial KEYNOTE-033 were utilized for constructing a partitioned survival model for cost-effectiveness analysis.Incremental cost-utility ratio(ICUR)served as a primary outcome measure with a study period of 7 years and a model cycle of 21 days.Deterministic sensitivity and probabilistic sensitivity analyses were performed for assessing parameteric uncertainty and model result stability.RESULTS ICUR value for pembrolizumab versus docetaxel was calculated as 619943.73 CNY/QALY,falling below a willingness to pay(WTP)threshold of 257094 CNY/QALY.Deterministic sensitivity analysis revealed that cost of pembrolizumab,progressive disease(PD)utility value and progression-free survival(PFS)utility value exerted significant effects on the results.Probabilistic sensitivity analysis indicated that docetaxel exhibited better costeffectiveness when WTP threshold was set at three folds of per capita gross domestic product(GDP).CONCLUSION In light of current domestic economic conditions,docetaxel is more cost-effective than pembrolizumab for advanced squamous NSCLC with low PD-L1 expression.