Abstract：
BACKGROUND: Bevacizumab shows superior efficacy in cerebral radiation necrosis (CRN) therapy, but its economic burden remains heavy due to the high drug price. This study aims to evaluate the cost-effectiveness of bevacizumab for CRN treatment from the Chinese payers\' perspective.
METHODS: A decision tree model was developed to compare the costs and health outcomes of bevacizumab and corticosteroids for CRN therapy. Efficacy and safety data were derived from the NCT01621880 trial, which compared the effectiveness and safety of bevacizumab monotherapy with corticosteroids for CRN in nasopharyngeal cancer patients, and demonstrated that bevacizumab invoked a significantly higher response than corticosteroids (65.5% vs. 31.5%, P < 0.001) with no significant differences in adverse events between two groups. The utility value of the \"non-recurrence\" status was derived from real-world data. Costs and other utility values were collected from an authoritative Chinese network database and published literature. The primary outcomes were total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). The uncertainty of the model was evaluated via one-way and probabilistic sensitivity analyses.
RESULTS: Bevacizumab treatment added 0.12 (0.48 vs. 0.36) QALYs compared to corticosteroid therapy, along with incremental costs of $ 2010 ($ 4260 vs. $ 2160). The resultant ICER was $ 16,866/QALY, which was lower than the willingness-to-pay threshold of $ 38,223/QALY in China. The price of bevacizumab, body weight, and the utility value of recurrence status were the key influential parameters for ICER. Probabilistic sensitivity analysis revealed that the probability of bevacizumab being cost-effectiveness was 84.9%.
CONCLUSIONS: Compared with corticosteroids, bevacizumab is an economical option for CRN treatment in China.
METHODS: A decision tree model was developed to compare the costs and health outcomes of bevacizumab and corticosteroids for CRN therapy. Efficacy and safety data were derived from the NCT01621880 trial, which compared the effectiveness and safety of bevacizumab monotherapy with corticosteroids for CRN in nasopharyngeal cancer patients, and demonstrated that bevacizumab invoked a significantly higher response than corticosteroids (65.5% vs. 31.5%, P < 0.001) with no significant differences in adverse events between two groups. The utility value of the \"non-recurrence\" status was derived from real-world data. Costs and other utility values were collected from an authoritative Chinese network database and published literature. The primary outcomes were total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). The uncertainty of the model was evaluated via one-way and probabilistic sensitivity analyses.
RESULTS: Bevacizumab treatment added 0.12 (0.48 vs. 0.36) QALYs compared to corticosteroid therapy, along with incremental costs of $ 2010 ($ 4260 vs. $ 2160). The resultant ICER was $ 16,866/QALY, which was lower than the willingness-to-pay threshold of $ 38,223/QALY in China. The price of bevacizumab, body weight, and the utility value of recurrence status were the key influential parameters for ICER. Probabilistic sensitivity analysis revealed that the probability of bevacizumab being cost-effectiveness was 84.9%.
CONCLUSIONS: Compared with corticosteroids, bevacizumab is an economical option for CRN treatment in China.
摘要：
背景：贝伐单抗在脑放射性坏死（CRN）治疗中显示出优异的疗效，但是由于药品价格高昂，其经济负担仍然很重。本研究旨在从中国付款人的角度评估贝伐单抗治疗CRN的成本-效果。
方法：建立了一个决策树模型来比较贝伐单抗和皮质类固醇用于CRN治疗的成本和健康结果。疗效和安全性数据来自NCT01621880试验，比较了贝伐单抗单药与糖皮质激素治疗鼻咽癌患者CRN的有效性和安全性，并证明贝伐单抗引起的反应明显高于皮质类固醇（65.5％vs.31.5%,P<0.001），两组之间的不良事件无显着差异。“非重复”状态的效用值是从真实世界数据中导出的。成本和其他效用值是从权威的中国网络数据库和已发表的文献中收集的。主要结果是总成本，质量调整寿命年(QALYs)，和增量成本效益比(ICER)。通过单向和概率敏感性分析对模型的不确定性进行评估。
结果：贝伐单抗治疗增加0.12（0.48vs.0.36)QALY与皮质类固醇治疗相比，以及2010年的增量成本(4260美元与2160美元)。由此产生的ICER为$16,866/QALY，低于中国38223美元/QALY的支付意愿门槛。贝伐单抗的价格,体重,复发状态的效用值是ICER的关键影响参数。概率敏感性分析显示，贝伐单抗的成本-效果概率为84.9%。
结论：与皮质类固醇相比，贝伐单抗是中国CRN治疗的一种经济选择。
方法：建立了一个决策树模型来比较贝伐单抗和皮质类固醇用于CRN治疗的成本和健康结果。疗效和安全性数据来自NCT01621880试验，比较了贝伐单抗单药与糖皮质激素治疗鼻咽癌患者CRN的有效性和安全性，并证明贝伐单抗引起的反应明显高于皮质类固醇（65.5％vs.31.5%,P<0.001），两组之间的不良事件无显着差异。“非重复”状态的效用值是从真实世界数据中导出的。成本和其他效用值是从权威的中国网络数据库和已发表的文献中收集的。主要结果是总成本，质量调整寿命年(QALYs)，和增量成本效益比(ICER)。通过单向和概率敏感性分析对模型的不确定性进行评估。
结果：贝伐单抗治疗增加0.12（0.48vs.0.36)QALY与皮质类固醇治疗相比，以及2010年的增量成本(4260美元与2160美元)。由此产生的ICER为$16,866/QALY，低于中国38223美元/QALY的支付意愿门槛。贝伐单抗的价格,体重,复发状态的效用值是ICER的关键影响参数。概率敏感性分析显示，贝伐单抗的成本-效果概率为84.9%。
结论：与皮质类固醇相比，贝伐单抗是中国CRN治疗的一种经济选择。
