注射用紫杉醇(白蛋白结合型)治疗转移性乳腺癌的成本-效用分析

Cost-Effectiveness Analysis of Paclitaxel for Injection (Albumin-binding) in the Treatment of Metastatic Breast Cancer

目的白蛋白结合型紫杉醇(nab-PTX)能够克服普通紫杉醇治疗存在的不足,在提高紫杉醇治疗效果同时可降低紫杉醇的不良反应。为了更好地支持国内转移性乳腺癌(MBC)相关医疗保险政策制定,本研究对于临床常用nab-PTX的治疗模式[每三周给药模式(Q3)]和多西他赛(DTX)Q3方案进行了成本-效用分析。方法采用马尔可夫模型设计,构建成本-效用模型,模拟国内MBC患者接受两种治疗方案下的终生健康结果和直接医疗费用,开展成本-效用分析。模型队列、临床疗效以及生命质量参数数据来源为已发表文献。模型费用参数则通过卫生资源使用数量和国内一家三甲医院卫生资源单价进行成本核算获得。结果基本情况分析结果表明,nab-PTX Q3方案相对DTX Q3方案增加0.178生命质量调整年(QALY),节约患者终生直接医疗费用$4326,具有绝对成本-效用优势。单因素敏感性分析表明,影响nab-PTX Q3方案成本-效用的主要模型参数是nab-PTX Q3治疗方案的临床疗效。通过10 000次蒙特卡罗模拟的概率敏感性分析结果表明,nab-PTX Q3方案相对于DTX Q3方案在3倍2017年人均国民生产总值($178 980)成本-效用阈值下的成本-效用优势概率为97.5%。结论在3倍2017年人均国民生产总值情况下,nab-PTX Q3方案相对于DTX Q3方案治疗MBC更具有经济性。

Objective Albumin bound paclitaxel(nab-PTX)can overcome the shortcomings of normal oaclitaxel in the treatment,which can achieve better the treatment outcomes than normal paclitaxel by improving bioavailabilityas well as and reducinge its toxicity.To support the reimbursement policy making related to the treatment of metastatic breast cancer(MBC)in China,this study conducted a cost-effectiveness analysis comparing nab-PTX administrated every 3 weeks(nab-PTX Q3)versus docetaxel administrated every 3 weeks(DTX Q3)in Chinese patients with MBC.Methods A markov model was developed to conduct cost effectiveness analysis.The cost-effectiveness analysis was conducted by simulating life-long health outcomes and direct medical costs of domestic MBC patients receiving under both treatment regimens.The model variables for model cohort,treatment effects,and quality of life were estimated from the performed published literatures review.The model cost parameters were obtained through cost accounting based on the amount of health resources used and the unit price of health resources in a domestic top three hospital.The model variables for costs were based on the estimated utilization of health resources associated with treatment,adverse events,and disease management associated with progression-free survival and progressive diseases in Chinese patients with MBC.Results The base case analysis indicated the cost-effectiveness dominance of nab-PTX Q3 over DTX Q3 by gaining 0.178 quality adjusted life years(QALY)and saving$4,326 for lifetime direct medical costs.One-way sensitivity analysis identified that the cost-effectiveness of nab-PTX Q3 was mainly driven by the treatment effects of nab-PTX Q3.Probabilistic sensitivity analysis with10,000 Monte Carlo simulations confirmed the robustness of the cost-effectiveness of nab-PTX Q3 by indicating 97.5%chance for nab-PTX Q3 to be attractive when compared to DTX Q3 under the Chinese cost-effectiveness threshold of 3 times Per Capita Gross National Product of China in 2017($178,980).Conclusion Nab-PTX Q3 was likely to be cost-effective for metastatic breast cancerMBC in China compared with DTX Q3 when theunder the condition of 3 times Per Capita Gross National Product of China willingness-to-pay(WTP)thresholds were$178,980/QALY.