曲妥珠单抗联合化疗治疗HER-2阳性晚期胃癌的成本-效果分析

目的 从卫生体系角度出发,评价曲妥珠单抗联合化疗对比单纯化疗治疗HER-2阳性晚期胃癌的成本效果。方法 参考1项Ⅲ期临床试验数据（ToGA研究）构建分区生存模型,通过拟合最佳参数来外推生存曲线模拟患者终生,以质量调整生命年（QALY）来计算增量成本-效果比（ICER）,通过单因素敏感性分析和概率敏感性分析验证基础分析结果的稳健性。结果 基础分析结果显示：曲妥珠单抗联合化疗较单纯化疗增加0.19 QALY的同时,需增加成本65 352.42元,大于支付意愿阈值（WTP）。单因素敏感性分析显示：对模型最敏感的3个因素为：无进展生存期（PFS）和进展期（PD）的效用值和曲妥珠单抗的成本。概率敏感性分析显示：当WTP＜320 000.00元时,曲妥珠单抗联合化疗组具有经济性的概率低于45.6%。结论 曲妥珠单抗联合化疗方案治疗HER-2阳性晚期胃癌目前不具有经济性。     

TCH新辅助化疗联合曲妥珠单抗治疗乳腺癌骨转移患者的效果

目的：分析曲妥珠单抗与TCH新辅助化疗联合治疗乳腺癌骨转移的效果。方法：抽取本院2019年2月—2022年3月收治的乳腺癌骨转移患者70例作为研究对象,依据其住院号尾数作奇偶数分为试验组和参照组,每组35例。对照组给予TCH新辅助化疗治疗,试验组在对照组基础上给予曲妥珠单抗治疗,比较两组治疗有效率、血清指标（OSC、OPG）、不良反应发生情况及满意度评分。结果：试验组治疗有效率为97.14%,高于参照组的82.86%(P<0.05)。治疗后,两组OSC、OPG水平低于治疗前,且试验组低于参照组（P<0.05）;两组肝肾功能损伤、白细胞减少、血小板降低、红血细胞减少、恶心呕吐发生率比较,差异无统计学意义（P>0.05）;试验组治疗方式、治疗效果满意度评分均高于参照组（P<0.05）。结论：曲妥珠单抗联合TCH新辅助化疗治疗乳腺癌骨转移的疗效确切,可有效降低相关血清指标,提高临床治疗满意度。     

辅助化疗联合曲妥珠单抗治疗人表皮生长因子受体-2阳性晚期或转移性乳腺癌的系统评价

目的：系统评价辅助化疗联合曲妥珠单抗治疗人表皮生长因子受体-2（HER2）阳性晚期或转移性乳腺癌的临床效果。方法：检索国内外公开发表的关于辅助化疗联合曲妥珠单抗治疗HER2阳性晚期或转移性乳腺癌的中英文文献,对纳入的研究进行比较。结果：共纳入6篇随机对照试验（RCT）研究。辅助化疗联合曲妥珠单抗治疗HER2阳性晚期或转移性乳腺癌的反应率和病理完全缓解率的风险比（RR）分别为1.46（P=0.02）和0.98（P=0.91）。结论：尽管研究存在一定的局限性,但在不考虑治疗成本的情况下,辅助化疗联合曲妥珠单抗治疗要优于标准治疗,临床上具有较强的可替代性。     

贝伐珠单抗用于卵巢癌治疗的经济学研究综述

目的 对贝伐珠单抗用于卵巢癌治疗的经济学研究进行综述,为贝伐珠单抗在卵巢癌治疗中的应用提供参考。方法 检索PubMed、Medline、Cochrane图书馆、中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VIP）、万方数据发表的贝伐珠单抗用于卵巢癌治疗的经济学评价文献并对其进行综述。结果 共纳入10项贝伐珠单抗用于卵巢癌治疗的药物经济学研究。对于卵巢癌一线化疗,多数研究结果表明贝伐珠单抗联合标准化疗方案相比单一化疗方案用于卵巢癌一线治疗的增量成本效果比超出了常用的意愿支付阈值。对于二线化疗,有研究显示贝伐珠单抗加入化疗方案具成本效果。结论 在常用的意愿支付阈值下,贝伐珠单抗加入到卵巢癌标准一线化疗方案相比单一化疗方案不具有成本效果。当贝伐珠单抗价格降低一定程度,贝伐珠单抗联合标准化疗的方案对于进展高风险的卵巢癌患者可成为具成本效果的选择。贝伐珠单抗用于铂耐药的卵巢癌治疗可具成本效果。     

曲妥珠单抗联合长春瑞滨或吉西他滨对人类表皮生长因子受体2阳性乳腺癌患者的临床观察

目的 探讨曲妥珠单抗联合长春瑞滨或吉西他滨对人类表皮生长因子受体2（HER-2）阳性乳腺癌患者的临床研究。方法 选择2012年1月-2015年12月汉中市三二〇一医院收治的103例HER-2阳性乳腺癌患者，根据随机数字表法，分为A组（49例）及B组（54例），A组给予曲妥珠单抗联合长春瑞滨，B组给予曲妥珠单抗联合吉西他滨，21 d为1个疗程，共用4~6个疗程。观察两组的实体瘤疗效、健康生存质量、治疗后1、2年生存率、总生存时间、无进展生存时间及毒副反应。结果 A组部分缓解率及客观有效率明显高于B组，差异有统计学意义（P<0.05）；两组完全缓急、疾病稳定及病情进展对比无统计学意义。A组的健康生存质量评分明显高于B组，差异有统计学意义（P<0.05）。A组治疗后1、2年的生存率高于B组，A组的总生存期及无进展生存时间长于B组，但差异无统计学意义。两组毒副反应对比无统计学意义。结论 与吉西他滨联合曲妥珠单抗对比，长春瑞滨联合曲妥珠单抗治疗HER-2阳性乳腺癌患者的部分缓解率、客观有效率及健康生存质量较高，且毒副反应患者可耐受，值得临床推广应用。     

曲妥珠单抗联合化疗治疗HER2阳性乳腺癌经济性的系统综述

目的：对曲妥珠单抗联合化疗治疗HER2阳性乳腺癌的药物经济学进行系统分析。方法： 计算机检索PubMed、ScienceDirect、SpringerLink等数据库2003—2013年间已发表的药物经济学文献,按照一定标准进行筛选,根据药物经济学方法,进行系统综述。结果：曲妥珠单抗治疗的增量成本效果比（ICER）值美国在34307~126933美元每QALY之间,瑞典为35975~52753欧元每QALY,挪威每一个LYS需要多付出8148~162417欧元,日本为17000欧元每LYG。结论：曲妥珠单抗联合化疗治疗HER2阳性乳腺癌是否具有经济性的研究结论不一致。在15篇研究中,有4篇研究认为曲妥珠单抗联合化疗方案不具有成本效果。     

临床药师参与1例炎性乳腺癌患者新辅助化疗的药学监护

目的:探讨乳腺癌患者新辅助化疗的药学监护模式。方法:对1例炎性乳腺癌患者进行药学监护。患者开始选用多西他赛+卡铂+曲妥珠单抗(TCH)的治疗方案;病情进展后,考虑TCH治疗方案中紫杉醇类可能发生耐药,将治疗方案换成长春瑞滨+顺铂+曲妥珠单抗(NPH)。结果与结论:临床药师可从合理选药、规范给药、患者教育及用药信息咨询三大方面对乳腺癌患者进行药学监护,从个体化用药角度出发,进一步完善药学监护模式,从而提高乳腺癌患者的药物治疗效果。     

卡瑞利珠单抗联合卡铂和培美曲塞一线治疗晚期非鳞状非小细胞肺癌患者的成本-效果分析

目的 在2020年新版医保目录执行后癌症免疫治疗类药品降价的背景下，从卫生体系的角度，研究获批一线治疗晚期非鳞状非小细胞肺癌适应证的卡瑞利珠单抗联合化疗药品（卡铂和培美曲塞）与化疗药品单独使用的成本-效果，评估降价后药品的经济性。方法 基于一项在中国患者人群内开展的临床试验（CameL），通过建立分区生存模型，评价卡瑞利珠单抗联合用药相对于单纯使用化疗药品在治疗时所产生的增量成本效果，并对主要参数进行确定敏感性分析和概率敏感性分析。结果 基础分析显示卡瑞利珠单抗联合化疗药品相对于单纯使用化疗药品的增量成本效果比为164 271.19元/QALY，降至3倍中国人均GDP（217 341元）的意愿支付阈值以内。确定敏感性分析显示，与卡瑞利珠单抗联合使用的化疗药物的成本是增量成本效果比的主要影响因素之一；概率敏感性分析显示，当意愿支付阈值为3倍人均GDP时，卡瑞利珠单抗联合用药相对于单纯使用化疗药品具有成本效果的概率为82.0%。结论 对于晚期非鳞状非小细胞肺癌的患者，一线使用卡瑞利珠单抗联合化疗药品（卡铂和培美曲塞）具有成本效果优势。     

2020—2022年辽宁省肿瘤医院单抗类靶向治疗药物使用情况分析

目的 分析辽宁省肿瘤医院2020—2022年单抗类靶向药物的使用情况以及变化趋势，为临床抗肿瘤药安全合理经济用药提供参考依据。方法 收集2020—2022年辽宁省肿瘤医院单抗类靶向药物使用数据，分析销售金额、用药频度（DDDs）、限定日费用（DDC）以及排序比（B/A）。结果 2020—2022年单抗类靶向药物销售金额逐年增长。贝伐珠单抗和曲妥珠单抗连续3年销售金额排名前2位。帕妥珠单抗由2020年的第5位增长到2022年的第3位。曲妥珠单抗DDDs连续3年均排在第1位。2022年新增品种（维迪西妥单抗、维布妥昔单抗、达雷妥尤单抗等）销售金额和DDDs排名均相对靠后，但其DDC值较高。地舒单抗、曲妥珠单抗、帕妥珠单抗、伊尼妥单抗等的DDC值较低，且B/A＞1，利妥昔单抗、贝伐珠单抗的B/A＜1。结论 2020—2022年辽宁省肿瘤医院单抗类靶向药物的结构总体上较为合理，能满足患者的医疗需求，保障患者用药的安全、有效和经济。     

曲妥珠单抗联合化疗用于Her-2阳性晚期胃癌的成本-效果分析

目的:研究曲妥珠单抗联合化疗用于人表皮生长因子受体2(Her-2)阳性晚期胃癌患者的成本-效果优势。方法:根据To GA临床试验数据,结合我国医疗费用及消费水平,进行成本-效果分析,并对结果进行敏感度分析。结果:曲妥珠单抗联合化疗方案相较于单纯化疗方案,每例患者总生存期增加1个月,需多花费55 822.4元。结论:曲妥珠单抗联合化疗方案用于Her-2阳性晚期胃癌不具有成本-效果优势。     

基于ADRB2基因检测的汉族COPD患者使用干粉吸入剂治疗的成本效果分析

目的 对COPD患者使用干粉吸入剂（dry powder inhalers,DPIs）治疗前是否进行ADRB2基因检测进行成本-效果分析,为基于药物基因组学选用药品提供经济学参考。方法 从全社会角度出发,构建决策树模型,基于ADRB2基因检测对汉族COPD患者进行DPIs治疗的医疗成本和效果进行计算,采用成本-效果分析方法评价其经济性,并进行敏感性分析。结果 成本-效果分析结果显示,应用DPIs前进行ADRB2基因检测的治疗策略（ADRB2 testing,AT）的期望总成本为12 170.78元,期望质量调整生命年（quality-adjusted life years,QALY）为0.411 8,成本效果比（cost-effectiveness ratio,CER）为29 555.08元/QALY;未进行基因检测（no testing,NT）的治疗策略期望总成本为11 711.01元,期望QALY为0.407 8,CER为28 717.53元/QALY。2种治疗策略的增量成本效果比（incremental cost effectiveness ratio,ICER）为114 942.96,低于本研究的意愿支付水平（2017年我国人均GDP的3倍,即177 785.28元）,说明AT方案具有经济性。单因素敏感性分析表明,ADRB2基因检测价格、ADRB2基因多态性对ICER结果影响较大;概率敏感性分析表明,2种治疗策略相比,AT方案具有一定经济性,但优越性相对不明显。结论 在意愿支付水平内,AT方案是经济学可以接受的方案,但敏感性分析结果尚不能确定哪一种方案为最优方案。     

A cost-effectiveness analysis of calcipotriol plus betamethasone dipropionate aerosol foam versus gel for the topical treatment of plaque psoriasis

Background: Calcipotriol 50 µg/g and betamethasone 0.5?mg/g dipropionate (Cal/BD) aerosol foam formulation provides greater effectiveness and improved patient preference compared with traditional Cal/BD formulations for the topical treatment of plaque psoriasis.

Objective: To determine the cost-effectiveness of Cal/BD foam compared with Cal/BD gel from the Australian perspective.

Methods: A Markov model was developed to evaluate the cost-effectiveness of topical Cal/BD foam and gel for the treatment of people with plaque psoriasis. Treatment effectiveness, safety, and utilities were based on a randomized control trial, resource use was informed by expert opinion, and unit costs were obtained from public sources. Outcomes were reported in terms of 1-year costs, quality-adjusted life years, and incremental cost-effectiveness ratios. All costs were reported in 2017 Australian Dollars.

Results: The model showed that patients using Cal/BD foam had more QALYs and higher costs over 1 year compared with patients using Cal/BD gel, resulting in a cost of $13,609 per QALY gained at 4-weeks. When 4 weeks of Cal/BD foam was compared with 8 weeks of Cal/BD gel treatment, Cal/BD foam was $8 less expensive and resulted in 0.006 more QALYs gained. Sensitivity analyses showed that, compared with Cal/BD ointment, Cal/BD foam was associated with an incremental cost of $15,091 per QALY gained.

Conclusion: Cal/BD foam is the most cost-effective Cal/BD formulation for the topical treatment of patients with plaque psoriasis.     

Evaluation of the cost-effectiveness of rifaximin-α for the management of patients with hepatic encephalopathy in the United Kingdom

Objective: Rifaximin-α 550?mg twice daily plus lactulose has demonstrated efficacy in reducing recurrence of episodes of overt hepatic encephalopathy (OHE) and the risk of hepatic encephalopathy (HE)-related hospitalizations compared with lactulose alone. This analysis estimated the cost effectiveness of rifaximin-α 550?mg twice daily plus lactulose versus lactulose alone in United Kingdom (UK) cirrhotic patients with OHE.

Method: A Markov model was built to estimate the incremental cost-effectiveness ratio (ICER). The perspective was that of the UK National Health Service (NHS). Clinical data was sourced from a randomized controlled trial (RCT) and an open-label maintenance study in cirrhotic patients in remission from recurrent episodes of OHE. Health-related utility was estimated indirectly from disease-specific quality of life RCT data. Resource use data describing the impact of rifaximin-α on hospital admissions and length of stay for cirrhotic patients with OHE was from four single-center UK audits. Costs (2012) were derived from published sources; costs and benefits were discounted at 3.5%. The base-case time horizon was 5 years.

Results: The average cost per patient was £22,971 in the rifaximin-α plus lactulose arm and £23,545 in the lactulose arm, a saving of £573. The corresponding values for benefit were 2.35 quality adjusted life years (QALYs) and 1.83 QALYs per person, a difference of 0.52 QALYs. This translated into a dominant base-case ICER. Key parameters that impacted the ICER included number of hospital admissions and length of stay.

Conclusion: Rifaximin-α 550?mg twice daily in patients with recurrent episodes of OHE was estimated to generate cost savings and improved clinical outcomes compared to standard care over 5 years.     

Cost effectiveness of trastuzumab in the adjuvant treatment of early breast cancer: a lifetime model

BACKGROUND: Recent randomised trials have demonstrated a statistically significant effect of trastuzumab on disease-free survival when used as adjuvant therapy for human epidermal growth factor receptor 2 protein (HER2)-positive resectable early stage breast cancer, with a treatment course lasting either 9 or 52 weeks. However, the cost effectiveness of adjuvant trastuzumab with respect to mortality remains uncertain, especially in an Australian setting. OBJECTIVE: To estimate the cost effectiveness of trastuzumab in Australia, in a cohort of 50-year-old patients with HER2-positive breast cancer over a lifetime, using (i) disease-free survival and cardiotoxicity data from recent randomised trials; (ii) information on long-term survival of patients with treated primary breast cancer; and (iii) costs of treating local and distant relapses and disease from causes other than breast cancer. METHODS: A Markov model consisting of four health states (remission, loco-regional recurrence, metastatic disease and death) was developed. Transition probabilities corresponded to patterns of relapse and metastases seen in recent trials. The model was run until age 100 years to allow calculation of average survival. Outcome measures were life-years and QALYs (calculated using utility weights reported in the literature).The model was calibrated to reflect literature evidence that the risk of breast cancer recurrence following primary treatment diminishes progressively to zero after about 20 years. It was assumed that the morbidity benefit of trastuzumab observed in trials would be present for 5 years but would then diminish progressively to zero after 8 years. Costs (year 2005 values) and benefits were discounted at 3% per annum. RESULTS: For every 1000 patients treated with a 52-week course of trastuzumab, there were 136 fewer breast cancer deaths (relative risk reduction 28%). The incremental cost-effectiveness ratios (ICERs) were Australian dollars ($ A)13 730 per year of life saved (YOLS) and $ A22 793 per QALY. The net incremental cost was $ A56.3 million ($ A414 012/cancer death avoided). Cost effectiveness declined (ICER = $ A27 734/QALY) in older patients (age 65 years at treatment initiation).The ICER was driven mainly by the drug acquisition costs, the assumption of the duration of benefit and the discount rate. Cost offsets from reduced costs of treating recurrent or metastatic breast cancer during follow-up were present but these factors were of less importance according to sensitivity analyses. The 9-week treatment schedule approached economic dominance (ICER = $ A1700/QALY) because of decreased costs, improved relative risk for prevention of metastases and more cancer deaths avoided (196). CONCLUSION: The results suggest that trastuzumab as adjuvant therapy for early breast cancer may be cost effective when given over either 52 or 9 weeks at current acquisition costs in Australia. However, the overall budget impact of the 52-week course is significant, and the 9-week course appears economically attractive.     

Cost–utility analysis of reslizumab for patients with severe eosinophilic asthma inadequately controlled with high-dose inhaled corticosteroids and long-acting β2-agonists in South Korea

Objectives: We aimed to assess the cost-utility of reslizumab for patients with severe eosinophilic asthma uncontrolled with high-dose inhaled corticosteroids and long-acting β₂-agonists (ICS/LABAs) in Korea.

Methods: A Markov model with limited societal perspective was used to compare the costs and quality-adjusted life years (QALYs) of reslizumab add-on therapy with standard-of-care (high-dose ICS/LABA) and standard-of-care alone. The model adopted a 4?week cycle with the following six health states over a lifetime (60?years): controlled asthma, uncontrolled asthma, moderate exacerbation, severe exacerbation, all-cause death and asthma-related death. The population comprised adult patients (age ≥18?years) with severe eosinophilic asthma (eosinophils ≥400 cells/μL) at Global Initiative for Asthma (GINA) step 4 or 5 who had experienced at least three exacerbations in the preceding year. Model inputs were sourced from individual patient-level data from two 52?week randomized controlled trials of reslizumab (NCT01287039, NCT01285323). The model included discontinuation rules where patients uncontrolled with reslizumab add-on therapy were transitioned to the standard-of-care arm. Costs and QALYs were annually discounted at 5%. Deterministic and probabilistic sensitivity analyses were performed.

Results: Reslizumab add-on therapy was associated with increased cost (US$119,394) and improved QALYs (5.17) compared with standard-of-care alone, resulting in an incremental cost-effectiveness ratio of US$23,081 per QALY gained. Body weight, time horizon and discount rate were influential factors in the model.

Conclusions: The addition of reslizumab to high-dose ICS/LABA was cost-effective in Korean patients with severe eosinophilic asthma uncontrolled with high-dose ICS/LABA, based on the threshold of 1 gross domestic product in Korea.     

Cost-utility analysis in a UK setting of self-monitoring of blood glucose in patients with type 2 diabetes

ABSTRACT

Background: Self-monitoring of blood glucose (SMBG) in type 2 diabetes patients has been shown in meta-analyses of randomized trials to improve HbA_1c by ～0.4% when compared to no SMBG. However, the cost of testing supplies is high, improvements in health utility due to improved glycaemic control may be possible and cost-effectiveness has not been evaluated.

Methods: A peer-reviewed validated model projected improvements in lifetime quality-adjusted life years (QALYs), long-term costs and cost-effectiveness of SMBG versus no SMBG. Markov/Monte Carlo modelling simulated the progression of complications (cardiovascular, neuropathy, renal and eye disease). Transition probabilities and HbA_1c-dependent adjustments came from the United Kingdom Prospective Diabetes Study (UKPDS) and other major studies. Effects of SMBG on HbA_1c came from clinical studies, meta-analyses and population studies, but can only be considered ‘moderate’ levels of evidence. Costs of complications were retrieved from published sources. Direct costs of diabetes complications and SMBG were projected over patient lifetimes from a UK National Health Service perspective. Outcomes were discounted at 3.5% annually. Extensive sensitivity analyses were performed.

Results: Depending on the type of diabetes treatment (diet and exercise/oral medications/insulin), improvements in glycaemic control with SMBG improved discounted QALYs anywhere from 0.165 to 0.255 years, with increased total costs of £1013–£2564/patient, giving incremental cost-effectiveness ratios of £4508:£15?515/QALY gained, well within current UK willingness-to-pay limits. Results were robust under a wide range of plausible assumptions.

Conclusions: Based on the moderate level of clinical evidence available to date, improvements in glycaemic control with interventions, including SMBG, can improve patient outcomes, with acceptable cost-effectiveness ratios in the UK setting.     

帕妥珠单抗联合曲妥珠单抗、多西他赛一线治疗HER2阳性转移性乳腺癌的成本-效用分析

目的评价帕妥珠单抗联合曲妥珠单抗、多西他赛(PTD)方案相比曲妥珠单抗联合多西他赛(TD)方案一线治疗人表皮生长因子受体2(HER2)阳性转移性乳腺癌的经济性。方法从我国卫生体系角度出发,利用CLEOPATRA临床试验披露的生存数据和相关文献数据构建分区生存模型,模型模拟时限设为20年,循环周期为3周,贴现率为5%。模型的产出指标包括两种治疗方案的成本及质量调整生命年(QALYs)。意愿支付(WTP)阈值设为2020年我国1~3倍人均国内生产总值(GDP),即72000~216000元/QALY。采用单因素敏感性分析及概率敏感性分析评价模型参数变化对结果稳健性的影响。结果基础分析结果显示,在20年的模拟时限内,PTD方案较TD方案可带来更高的健康获益(3.28 QALYs vs.2.50 QALYs),但总成本更高(1219376.83元vs.784007.84元);与TD方案相比,PTD方案的增量成本-效果比为554625.46元/QALY,超过WTP阈值。单因素敏感性分析结果显示,疾病无进展生存状态的效用值对结果的影响最大。概率敏感性分析结果显示,使用我国2020年3倍人均GDP作为WTP阈值时,PTD方案具有经济性的概率为1%;当WTP阈值升至550000元/QALY时,PTD方案具有经济性的概率可达50%。结论与TD方案相比,PTD方案一线治疗HER2阳性转移性乳腺癌不具有经济性。     

阿法替尼和吉非替尼一线治疗EGFR突变阳性非小细胞肺癌的成本效用分析

目的 从中国医疗保健支付者的角度,评价阿法替尼与吉非替尼在表皮生长因子受体（epidermal growth factor receptor,EGFR）突变阳性非小细胞肺癌一线治疗中的成本效用。方法 基于一项高质量、多中心的二期随机临床试验（LUNG7）,依据疾病发展进程建立三状态Markov模型（无进展生存状态、疾病进展状态、死亡状态）,模型各状态转移概率与不良反应发生率通过临床试验数据提取并计算,效用值取自研究文献中的中国人群效用值,直接医疗成本取自本地收费或相关文献。对总人群Markov模型进行为期10年的成本效用评估,并对模型分析结果的稳定性进行确定敏感性和概率敏感性分析。结果 在基础分析中,10年间阿法替尼组相对于吉非替尼组需多花费$16 499.77,但同时可多获得0.29个质量调整生命年（quality-adjusted life years,QALYs）,其增量成本效果比（incremental cost-effectiveness ratio,ICER）为$57 428.17/QALY。此时ICER值高于中国支付意愿阈值（willingness to pay,WTP）$26 331/QALY,表明阿法替尼目前相对于吉非替尼不具经济优势。一维敏感性分析结果显示疾病进展阶段的效用值、吉非替尼和阿法替尼的价格以及无进展生存期效用值对结果的稳定性影响较大,但除吉非替尼价格外,其他变量均不能使ICER值降至WTP之下,表明模型结果稳定。结论 对于中国EFGR突变阳性非小细胞肺癌患者,阿法替尼在一线治疗中相对于吉非替尼当前没有表现出经济性。