Pd-1/PD-L1抑制剂联合疗法一线治疗晚期非小细胞肺癌的成本-效用分析

Cost-utility Analysis of PD-1/PD-L1 Inhibitor Combination Therapies as First-line Treatment for Advanced Non-small-cell Lung Cancer

目的 从中国医疗卫生体系的角度比较8种程序性死亡受体-1(programmed death 1,Pd-1)/程序性死亡配体-1(programmed cell death-ligand 1,PD-L1)抑制剂联合治疗方案用于一线治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的成本-效用性。方法 相关数据来源于已发表的网络荟萃分析和随机对照试验,建立三状态的马尔科夫模型,对8种免疫联合治疗组合进行成本-效用分析,采用敏感性分析来验证结果的稳健性,并进行一系列情景分析。结果 信迪利单抗联合化疗组和替雷利珠单抗联合化疗组的增量成本-效用比(incremental cost-utility ratio,ICUR)分别为125 143.88元/质量调整生命年(quality-adjusted life-year,QALY)和189 609.64元/QALY,小于意愿支付阈值(willingness-to-pay,WTP)257 094元/QALY,其余Pd-1/PD-L1抑制剂联合治疗方案的ICUR均>WTP,不具有经济性。情境分析发现,即使医保报销比例达到80%,帕博利珠单抗、阿替利珠单抗及纳武利尤单抗联合治疗方案均不具有经济性。结论 相比于其他Pd-1/PD-L1抑制剂联合治疗方案,信迪利单抗联合化疗及替雷利珠单抗联合化疗一线治疗晚期NSCLC具有成本-效用优势,可为NSCLC患者选用合理的治疗方案提供一定的参考依据。

OBJECTIVE To compare the cost-utility of eight programmed death 1(PD-1)/programmed cell death-ligand 1(PD-L1)inhibitor combination regimens for first-line treatment of advanced non-small cell lung cancer(NSCLC)from the perspective of Chinese healthcare system.METHODS Relevant data were derived from a published network meta-analysis and randomized controlled trails,a three-state Markov model was established to analyze the cost-utility of eight immunotherapy combinations.The robustness of results were validated through sensitivity analyses and a series of scenario analyses was also conducted.RESULTS The incremental cost-utility ratio(ICUR)of the sintilizumab plus chemotherapy group and the tislelizumab plus chemotherapy group were￥125143.88/quality adjusted life year(QALY)and￥189609.64/QALY,respectively,which were less than the willingness-to-pay(WTP)threshold of￥257094/QALY,and all the ICURs of other PD-1/PD-L1 inhibitor combination regimens exceeded the WTP threshold and were not economical.Scenario analyses found that even if the medical insurance reimbursement ratio reached 80%,the different combinations of pembrolizumab,nivolumab and atezolizumab were not economical.CONCLUSION Compared with other PD-1/PD-L1 inhibitor combination regimens,sintilizumab plus chemotherapy and tislelizumab plus chemotherapy have cost-utility advantages in the first-line treatment of advanced NSCLC,which can provide a certain reference for selecting a reasonable treatment plan for NSCLC patients.