目的:BETAcc临床试验表明,化疗联合贝伐单抗联合阿特珠单抗(CBA)可显着延长转移性肿瘤患者的无进展生存期(PFS)和总生存期(OS)。持久性,或复发性宫颈癌。然而,根据我们的知识,目前尚不清楚使用这种新疗法治疗该适应症的经济价值.因此,我们的研究旨在评估CBA用于转移性肿瘤一线治疗的成本效益,持久性,从美国医疗保健支付者的角度来看,或复发性宫颈癌。
方法:开发了一个10年生命周期的状态转移马尔可夫模型,以比较CBA与化疗加贝伐单抗(CB)的成本和有效性。我们研究的主要结果包括成本,质量调整寿命年(QALYs),和增量成本效益比(ICER)。进行单向敏感性分析和概率敏感性分析以评估结果的稳健性。
结果:与CB相比,CBA与额外的0.58QALY相关,额外费用为172,495.90美元。ICER为$295,972.43/QALY,显著高于支付意愿(WTP)阈值15万美元/QALY。单向敏感性分析显示,结果对PFD效用最敏感,阿替珠单抗的单位成本,和PD实用程序。概率敏感性分析表明,CBA在$150,000/QALY阈值下实现了4.3%的成本效益概率。为了实现成本效益,阿替珠单抗的单价必须降低约56.6%.
结论:与CB相比,CBA治疗不太可能是一种具有成本效益的选择,经常性,或美国的转移性宫颈癌。
OBJECTIVE: The BETAcc clinical trial demonstrated that chemotherapy combined with bevacizumab plus
atezolizumab (CBA) significantly prolonged progression-free survival (PFS) and overall survival (OS) in patients with metastatic, persistent, or recurrent cervical cancer. However, to our knowledge, the economic value of using this new therapy for this indication is currently unknown. Therefore, our study aims to evaluate the cost-effectiveness of CBA for the first-line treatment of metastatic, persistent, or recurrent cervical cancer from the United States healthcare payers perspective.
METHODS: A state-transition Markov model over a 10-year lifetime horizon was developed to compare the cost and effectiveness of CBA versus chemotherapy plus bevacizumab (CB). The primary outcomes of our study included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the results.
RESULTS: CBA was associated with an additional 0.58 QALY at an extra cost of $172,495.90 compared to CB. The ICER was $295,972.43/QALY, significantly higher than the willingness-to-pay (WTP) threshold value of $150,000/QALY. One-way sensitivity analyses revealed that results were most sensitive to the PFD utility, the unit cost of
atezolizumab, and PD utility. Probabilistic sensitivity analysis indicated that CBA achieved a 4.3% probability of cost-effectiveness at a $150,000/QALY threshold. To achieve cost-effectiveness, the unit price of
atezolizumab must be reduced by approximately 56.6%.
CONCLUSIONS: CBA treatment is unlikely to be a cost-effective option compared with CB for patients with persistent, recurrent, or metastatic cervical cancer in the United States.