目的:吉西他滨三联化疗的临床疗效,顺铂+S-1(GCS),durvalumab(DGC),或pembrolizumab(PGC)作为晚期胆道癌(BTC)的一线治疗已有报道。然而,它们的成本效益比较尚不清楚。我们从日本医疗保健支付者的角度进行了基于模型的成本效益分析。
方法:通过比较KHBO1401-MITSUBA的时间依赖性风险,构建了10年分区生存模型,TOPAZ-1和KEYNOTE-966试验。成本和效用来自先前发布的报告。使用质量调整生命年(QALY)来衡量对健康的影响。考虑了直接医疗费用。进行了单向分析和概率敏感性分析。每个QALY的支付意愿门槛为750万日元(57,034美元)。
结果:GCS每个QALY的增量成本,DGC,在基本案例研究中,PGC为3,779,374日元(28,740美元),86,058,056日元(65,4434美元),和28,982,059日元(220,396美元),分别。在单向敏感性分析中,没有参数的影响超过阈值。概率敏感性分析表明,GCS的概率,DGC,而PGC在门槛上的成本效益为85.6%,0%,0%,分别。
结论:鉴于目前的情况,在日本医疗保健系统中,利用GCS的三联疗法可能会成为晚期BTC患者的合理有效的主要化疗策略,而不是DGC和PGC。
OBJECTIVE: The clinical effectiveness of triple chemotherapy consisting of gemcitabine, cisplatin plus either S-1 (GCS),
durvalumab (DGC), or pembrolizumab (PGC) as first-line treatment for advanced biliary tract cancer (BTC) has been reported. However, their comparative cost-effectiveness is unclear. We conducted a model-based cost-effectiveness analysis from the perspective of Japanese healthcare payer.
METHODS: A 10-year partitioned survival model was constructed by comparing the time-dependent hazards of the KHBO1401-MITSUBA, TOPAZ-1, and KEYNOTE-966 trials. The cost and utility came from previously published reports. Quality-adjusted life years (QALY) were used to measure the effects on health. Costs for direct medical care were taken into account. There was a one-way analysis and a probability sensitivity analysis. A willingness-to-pay threshold of 7.5 million yen (57,034 USD) per QALY was defined.
RESULTS: The incremental costs per QALY for GCS, DGC, and PGC in the base case study were 3,779,374 JPY (28,740 USD), 86,058,056 JPY (65,4434 USD), and 28,982,059 JPY (220,396 USD), respectively. No parameter had an influence beyond the threshold in a one-way sensitivity analysis. A probabilistic sensitivity analysis revealed that the probability of GCS, DGC, and PGC being cost-effective at the threshold was 85.6%, 0%, and 0%, respectively.
CONCLUSIONS: Given the current circumstances, it is probable that triple therapy utilizing GCS will emerge as a plausible and efficient primary chemotherapy strategy for patients with advanced BTC in the Japanese healthcare system, as opposed to DGC and PGC.