阿替利珠单抗治疗转移性非小细胞肺癌的成本效用分析

目的： 评价阿替利珠单抗联合贝伐珠单抗及化疗（ABCP方案）一线治疗转移性非鳞状非小细胞肺癌的经济性。方法： 根据IMpower150临床试验，从中国卫生体系角度建立Markov模型。模型包括疾病未进展、疾病进展和死亡3个健康状态。模型的主要结果为总成本、生命年（life-year，LY）、质量调整生命年（quality adjusted LY，QALY）和增量成本效用比，还进行了一元敏感性分析和概率敏感性分析探讨参数的不确定性。结果： 基线分析结果显示：接受ABCP方案治疗比贝伐珠单抗联合化疗（BCP方案）治疗的患者增加了0.41 QALYs（0.45 LYs），相应的总成本也增加了690 997元；增量成本效用比为1 688 482元/QALY（1 519 390元/LY）。一元敏感性分析结果显示：对增量成本效用比影响最大的参数是阿替利珠单抗的每周期成本。概率敏感性分析结果显示：增量成本效用比大于意愿支付阈值（212 676元/QALY）的概率为100%。结论： 与BCP方案相比，ABCP方案治疗转移性非鳞状非小细胞肺癌不具有经济性。

Cost utility analysis of atezolizumab in the treatment of metastatic non-small cell lung cancer

OBJECTIVE To conduct economic evaluations of adding atezolizumab to bevacizumab plus chemotherapy(ABCP) for patients with metastatic nonsquamous non-small cell lung cancer.METHODS Based upon the IMpower150 trial,a Markov model was established from the Chinese healthcare perspective.The model included three health states of progression-free survival,progression disease and death.Outputs were total cost,life-year(LY),quality adjusted LY(QALY) and incremental cost-utility ratio(ICUR).And serial sensitivity analysis was conducted for exploring the uncertainty of the model.RESULTS The results of baseline analysis showed that patients receiving ABCP increased 0.41 QALYs(0.45 LYs) compared with bevacizumab plus chemotherapy(BCP) and the corresponding total cost increased by ￥690 997 ICUR was 1 688 482 ￥/QALY(1 519 390 ￥/LY).The results of 1-way sensitivity analyses showed that the cost per cycle of atezolizumab had the greatest impact on ICUR.The probability sensitivity analysis showed that the probability that ICUR greater than the willingness-to-pay threshold(212 676 ￥/QALY) was 100%.CONCLUSION Compared with BCP,ABCP is not cost-effective in the first-line setting for patients with metastatic nonsquamous non-small cell lung cancer.