■转移性非小细胞肺癌(mNSCLC)发病率高,以及病人的经济负担,医疗保健系统,和社会。Durvalumab联合曲美木单抗和化疗(T+D+CT)是mNSCLC的一种新的治疗策略,在一项3期随机临床试验中证明了有希望的疗效,但其经济价值尚不清楚。
■这项经济评估使用了一个假设的mNSCLC患者队列,具有反映POSEIDON试验参与者特征的特征。构建了几个分区生存模型来估计与T+D+CT相关的15年成本和健康结果。durvalumab联合化疗(D+CT)和单纯化疗(CT)策略,以每年3%的价格折扣成本和有效性。成本为2023年美元。数据来自POSEIDON试验和已发表的文献。进行了确定性和概率敏感性分析,以评估输入参数的不确定性并研究泛化性。该分析是在2022年9月至2023年3月设计和进行的。为了评估T+D+CT的成本效益,与CT和D+CT相比,从美国医疗保健部门和社会的角度来看mNSCLC。
■从医疗保健行业的角度来看,与CT相比,T+D+CT产生了额外的0.09个QALY,成本增加了7,108美元,这导致了82,501美元/QALY的ICER。与D+CT相比,T+D+CT策略额外产生0.02个QALY,成本增加27,779美元,这导致ICER为1,243,868美元/季度。T+D+CT的经济结果与CT对年贴现率最敏感,后续免疫治疗费用,tremelimumab成本,姑息治疗和死亡费用,培美曲塞费用,和durvalumab费用。在针对支付意愿的59%-82%的模型迭代中,T+D+CT策略相对于CT被认为是具有成本效益的。100,000美元/QALY的门槛提高到150,000美元/QALY。从社会的角度来看,与CT或D+CT相比,T+D+CT可以被认为是具有成本效益的,独立于组织学。
■在此成本效益分析中,从医疗保健部门和社会的角度来看,与CT相比,T+D+CT策略对mNSCLC患者具有良好的价值。这种治疗策略可以优先用于疾病进展高风险的mNSCLC患者。
UNASSIGNED: Metastatic non-small cell lung cancer (mNSCLC) has a high incidence rate, and economic burdens to patients, healthcare systems, and societies.
Durvalumab plus tremelimumab and chemotherapy (T+D+CT) is a novel therapeutic strategy for mNSCLC, which demonstrated promising efficacy in a phase-3 randomized clinical trial, but its economic value remains unclear.
UNASSIGNED: This economic evaluation used a hypothetical cohort of patients with mNSCLC, with characteristics mirroring those of the participants in the POSEIDON trial. Several partitioned survival models were constructed to estimate 15-year costs and health outcomes associated with the T+D+CT,
durvalumab plus chemotherapy (D+CT) and chemotherapy alone (CT) strategies, discounting costs and effectiveness at 3% annually. Costs were in 2023 US dollars. Data were derived from the POSEIDON trial and published literature. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of input parameters and study generalizability. The analysis was designed and conducted from September 2022 to March 2023. To evaluate the cost-effectiveness of T+D+CT, compared with CT and D+CT, for mNSCLC from the perspectives of the US healthcare sector and society.
UNASSIGNED: From the healthcare sector\'s perspective, the T+D+CT yielded an additional 0.09 QALYs at an increased cost of $7,108 compared with CT, which resulted in an ICER of $82,501/QALY. The T+D+CT strategy yielded an additional 0.02 QALYs at an increased cost of $27,779 compared with the D+CT, which resulted in an ICER of $1,243,868/QALY. The economic results of T+D+CT vs. CT were most sensitive to the annual discount rate, subsequent immunotherapy cost, tremelimumab cost, palliative care and death cost, pemetrexed cost, and
durvalumab cost. The T+D+CT strategy was considered cost-effective relative to CT in 59%-82% of model iterations against willingness-to-pay. thresholds of $100,000/QALY gained to $150,000/QALY gained. From the societal perspective, the T+D+CT can be considered as cost-effective as compared with CT or D+CT, independent of histology.
UNASSIGNED: In this cost-effectiveness analysis, the T+D+CT strategy represented good value compared with CT for patients with mNSCLC from the perspectives of the healthcare sector and the society. This treatment strategy may be prioritized for mNSCLC patients at high risks of disease progression.