卡瑞利珠单抗联合化疗对比化疗在晚期鳞状非小细胞肺癌一线治疗中的成本效果分析

目的: 从中国卫生体系角度出发,评价卡瑞利珠单抗联合化疗对比传统化疗一线治疗晚期鳞状非小细胞肺癌的成本效果。方法: 采用分区生存模型,计算95％患者死亡时的治疗成本、生存质量调整年和增量成本效果比,并进行单因素敏感性分析、概率敏感性分析和情景分析以检验基础结果的不确定性。结果: 相对于化疗组,卡瑞利珠单抗联合化疗成本增加100 397.39元,同时多获得0.52个QALY,增量成本效果比为191 281.04元/QALY;单因素敏感性分析显示,卡瑞利珠单抗成本、PFS状态效用和PD状态效用对结果影响较大;概率敏感性分析显示卡瑞利珠单抗联合化疗更具有成本效果的概率为96.7%;情景分析显示,当进展后治疗方案发生变化时,卡瑞利珠单抗组增量成本效果比未发生较大的变动,卡瑞利珠单抗治疗鳞状非小细胞肺癌纳入医保降价使其经济性增加。结论: 从中国卫生体系角度看,在晚期鳞状非小细胞肺癌的一线治疗中使用卡瑞利珠单抗联合化疗相对于化疗更具有成本效果优势。

Cost-effectiveness of camrelizumab combined with chemotherapy vs.chemotherapy alone as first-line treatment for advanced squamous non-small cell lung cancer

OBJECTIVE To evaluate the cost-effectiveness of camrelizumab combined with chemotherapy versus chemotherapy in the first-line treatment of advanced squamous non-small cell lung cancer from the perspective of Chinese health delivery system.METHODS A partitioned survival model was constructed to simulate the treatment cost,quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) at the time of death of 95% of patients,and deterministic sensitivity analysis (DSA),probability sensitivity analysis (PSA) and scenario analysis were performed to test the uncertainty of basic results.RESULTS The results of basic analysis showed that the cost of camrelizumab combined with chemotherapy increased by 100 397.39 yuan,and gained 0.52 QALY at the same time,compared with the chemotherapy group,the ICER was 191 281.04 yuan/QALY;DSA showed that the cost of camrelizumab,utilities of PFS and PD had a great impact on the results;The PSA showed that the probability that camrelizumab combined with chemotherapy was more cost-effective was 96.7%;Scenario analysis showed that when the treatment plan changes after progress,there are no major changes to ICER of camrelizumab group,The inclusion of camrelizumab in the treatment of squamous NSCLC in medical insurance and price reduction would increase its economy.CONCLUSION From the perspective of Chinese health delivery system,the use of camrelizumab combined with chemotherapy is more cost-effective than chemotherapy in the first-line treatment of advanced squamous NSCLC.