3种国产PD-1抑制剂治疗晚期非小细胞肺癌的药物经济学评价

Pharmacoeconomic evaluation of three domestic PD-1 inhibitors for advanced non-small cell lung cancer

目的:基于真实世界研究数据,探讨使用卡瑞利珠单抗、信迪利单抗和特瑞普利单抗治疗局部晚期及晚期的非小细胞肺癌(non-small cell lung cancer,NSCLC)的经济性。方法:回顾性纳入2019年3月至2023年2月在南部战区总医院使用卡瑞利珠单抗、信迪利单抗和特瑞普利单抗治疗局部晚期及晚期的NSCLC患者共149例,通过逆概率处理加权(inverse probabil⁃ity of treatment weighting,IPTW)方法消除组间混杂因素。基于IPTW处理后3组患者的无进展生存期(PFS)、总生存期(OS)与不良反应发生率建立分区生存模型来评价3种国产PD-1抑制剂用于治疗局部晚期及晚期NSCLC的成本效果,计算增量成本效果比。结果:进行IPTW处理后的3组患者mPFS(8.20个月vs.14.80个月vs.14.80个月)与mOS(未到达vs.22.70月vs.未到达)未见差异。任一药物发生率大于5%且等级≥3级的不良反应包括:贫血、白细胞计数减少、中性粒细胞计数减少和血小板计数减少。相比信迪利单抗,卡瑞利珠单抗和特瑞普利单抗分别增加了0.50和1.00个QALY临床获益,为增加1个QALY的临床获益需要额外投入的成本分为495151.83和440095.05元,而特瑞普利单抗相比卡瑞利珠单抗每增加1个QALY的获益需投入384563.57元,无论意愿支付值阈值设定为3倍全国人均GDP(257000元/QALY)还是3倍广东省人均GDP(305400元/QALY),相比信迪利单抗,使用卡瑞利珠单抗或是特瑞普利单抗治疗是不具有经济性的,且特瑞普利单抗对比卡瑞利珠单抗也不具备成本效果优势。结论:3种国产PD-1抑制剂中,信迪利单抗最具经济性的,其次是卡瑞利珠单抗,特瑞普利单抗再次之。

OBJECTIVE To evaluate the cost-effectiveness of camrelizumab,sintilimab and toripalimab for advanced nonsmall cell lung cancer(NSCLC)based upon real-world study data.METHODS From March 2019 to February 2023,149 patients with locally advanced and advanced NSCLC on camrelizumab,sintilimab and toripalimab were retrospectively reviewed at General Hospital of Southern Theater Command.Inverse probability of treatment weighting(IPTW)method was utilized for eliminating intergroup confounding factors.A partitioned survival model was established for evaluating the cost-effectiveness of three domestic PD-1 inhibitors for locally advanced and advanced NSCLC based upon progression-free survival(PFS),overall survival(OS)and the incidence of adverse reactions of three groups after IPTW.Incremental cost-effectiveness ratio was calculated.RESULTS After IPTW data processing,no difference existed in mPFS(8.20 vs.14.80 vs.14.80 month)or mOS(nonattained vs.22.70 month vs.non-attained)among three groups.Adverse reactions with an incidence of>5%and grade≥Ⅲfor either drug included anemia,leucopenia,neutropenia and thrombocytopenia.As compared with sintilimab,camrelizumab and toripalimab increased clinical benefit by 0.50 and 1.00 QALYs.However,additional costs for boosting the clinical benefit by 1 QALY were divided into￥495151.83 and￥440095.05.Toripalimab required an input of￥384563.57 for each additional QALY of benefit as compared with camrelizumab.Regardless of whether not willingness-to-pay(WTP)threshold was set at 3 folds per capita gross domestic product(￥257000/QALY)or 3 folds Guangdong’s per capita GDP(￥305400/QALY),camrelizumab and toripalimab were no cost-effectiveness as compared with sintilimab and toripalimab was no cost-effectiveness as compared with camrelizumab.CONCLUSION In terms of economy,sintilimab is the most cost effective followed by camrelizumab and toripalimab.