伏美替尼对比吉非替尼单药一线治疗表皮生长因子受体突变晚期非小细胞肺癌的成本-效果分析

Cost-effectiveness Analysis of Furmonertinib Compared to Gefitinib in First-line Monotherapy for Advanced Non-small Cell Lung Cancer with EGFR Mutation

目的从我国卫生体系角度出发,评价伏美替尼对比吉非替尼单药一线治疗表皮生长因子受体(EGFR)突变阳性晚期非小细胞肺癌的成本效用。方法基于Ⅲ期临床试验FURLONG研究,构建三状态的分区生存模型,并结合治疗成本、效用值、不良反应发生率、贴现率等参数,模拟得到总的增量成本效用比值(ICER),将ICER值与意愿支付值(WTP)进行比较,从而判断伏美替尼相较于吉非替尼单药一线治疗EGFR突变阳性晚期非小细胞肺癌的经济性。结果基础分析结果显示,伏美替尼组比吉非替尼组多支出成本85786元,但多获得了0.62个质量调整生命年(QALY),增量成本效用比值为138306元,小于我国3倍人均国内生产总值(GDP)。单因素敏感性分析显示,最佳支持治疗成本、无进展生存期(PFS)效用值和进展生存期(PD)效用值对ICER结果影响较大。概率敏感性分析结果显示,当WTP为3倍我国人均GDP时,伏美替尼组相比吉非替尼组具有经济性的概率为100.0%。情境分析结果验证了基础分析结果的稳健性。结论在2022年中国3倍人均GDP的意愿支付阈值下,选择伏美替尼单药用于一线治疗EGFR突变阳性晚期非小细胞肺癌相比吉非替尼更具经济性。

Objective From the perspective of China's health system,evaluate the cost-effectiveness of furmonertinib compared to gefitinib in first-line monotherapy for EGFR mutation-positive advanced non-small cell lung cancer.Methods Based on the FURLONG study of phase III clinical trials,a three-state partitioned survival model was constructed and combined with parameters such as treatment cost,utility value,the incidence of adverse reactions,and discount rate;the total incremental cost-effectiveness ratio(ICER)was simulated.Then,the ICER value was compared with the willingness to pay(WTP)value to determine the economic feasibility of furmonertinib compared to gefitinib as a first-line treatment for EGFR mutation-positive advanced non-small cell lung cancer.Results The basic analysis results show that the treatment group with furmonertinib incurred an additional cost of 85786 yuan compared to the treatment group with gefitinib,but obtained an additional 0.62 QALYs,with an incremental cost-effectiveness ratio of 138306 yuan,which is less than three times China's per capita GDP.One-way sensitivity analysis shows that the best support treatment cost,PFS utility value,and PD utility value significantly impact the ICER results.The results of probability sensitivity analysis show that when the WTP is three times China's per capita GDP,the probability of economic viability of the furmonertinib group compared to the gefitinib group is 100.0%.The scenario analysis results verified the robustness of the underlying analysis results.Conclusion Under the willingness to pay threshold of three times China's per capita GDP in 2022,Choosing furmonertinib as a first-line monotherapy for EGFR mutation-positive advanced non-small cell lung cancer is more cost-effective than gefitinib.