度伐利尤单抗用于广泛期小细胞肺癌一线治疗的药物经济学研究系统评价

Pharmacoeconomic evaluations of durvalumab as a first-line treatment for extensive-stage small cell lung cancer:a systematic review

目的:系统评价度伐利尤单抗用于广泛期小细胞肺癌(extensive-stage small cell lung cancer,ES-SCLC)一线治疗的药物经济学研究,为优化临床治疗方案、完善卫生决策及开展后续药物经济学研究提供参考。方法:通过PubMed、Embase、Cochrane Library、Web of Science、CNKI、SinoMed、VIP和WANFANG DATA数据库检索获取自建库起至2024年3月公开的相关文献,采用CHEERS 2022量表评估文献质量,对纳入文献的基本特征、模型结构及方法学、经济学结果等进行总结和归纳分析。结果:共纳入10篇文献,总体质量较好。研究视角包括卫生体系和医保支付方,均为基于模型法的成本-效用分析;效用值数据主要源于既有研究,成本数据主要测算直接医疗成本,生存数据拟合外推方法包括标准参数模型法和标准参数模型结合风险比调整法。度伐利尤单抗联合化疗(依托泊苷和铂类)与单纯化疗和阿替利珠单抗联合化疗相比,来自不同国家的10项研究结果均显示其不具有经济优势;接受慈善赠药或存在脑转移的ES-SCLC患者采用度伐利尤单抗联合化疗,相对阿替利珠单抗联合化疗具有经济优势,但相比单纯化疗则不具有经济优势;度伐利尤单抗相较于其他免疫检查点抑制剂(如帕博利珠单抗和伊匹木单抗),则具有显著经济优势。结论:该研究初步明确度伐利尤单抗联合化疗相较于其他药物治疗方案的经济性,未来的研究可利用头对头试验数据或真实世界数据,为ES-SCLC的治疗进一步提供证据。

OBJECTIVE To systematically evaluate the pharmacoeconomic researches on durvalumab as a first-line treatment for extensive-stage small cell lung cancer(ES-SCLC)so as to optimize clinical treatment plans,improve health decisions and provide references for subsequent pharmacoeconomic researches.METHODS A systematic review was conducted by accessing the databases of PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),SinoMed,VIP and WANFANG DATA.And the relevant literature items were up to March 2024.The qualities of included studies were assessed by the CHEERS 2022 checklist and followed by a descriptive summary analysis.RESULTS Ten studies of high overall quality were included.All were model-based cost-effectiveness analyses from the perspectives of health system and payers.Utility values were derived from prior researches and expenses focused upon direct medical costs.Survival data were projected by standard parametric and risk-adjusted models.Durvalumab plus chemotherapy(etoposide plus platinum)failed to demonstrate cost-effectiveness over chemotherapy alone or atezolizumab plus chemotherapy.However,in ES-SCLC patients with brain metastases or receiving patient assistance,durvalumab plus chemotherapy was economically favorable and more costeffective than atezolizumab plus chemotherapy and yet not over chemotherapy alone.As compared with such checkpoint inhibitors as pembrolizumab and ipilimumab,durvalumab offered a significant cost-effectiveness advantage.CONCLUSION This study has preliminarily clarified the economic viability of durvalumab as compared with other drug dosing regimens.Future researches should utilize head-to-head trial data or real-world data to provide further evidence for treating ES-SCLC.