■为了确定进口免疫检查点抑制剂(ICIs)的成本效益,如阿特珠单抗和durvalumab,和国内ICIs像serplulimab和adebrelimab,联合化疗治疗中国广泛期小细胞肺癌(ES-SCLC)。
■使用21天的周期长度和20年的时间范围,建立了Markov模型,比较了5种一线ICI加化疗与单纯化疗的临床和经济结果,以及彼此对抗,从中国医疗体系的角度来看。通过结合CAPSTONE-1试验的结果和已发表的网络荟萃分析来估计转移概率。从多个来源收集了成本和健康国家公用事业。成本和有效性结果都以每年5%的速度打折。主要模型输出是增量成本效益比(ICER)。进行了一系列敏感性分析,以评估模型的稳健性。
■在基本情况分析中,在化疗中增加一线ICIs导致ICER的范围从$80,425.31/QALY到$812,415.46/QALY,超过了该模型设定的支付意愿阈值。当比较这些一线免疫化疗策略时,serplulimab联合化疗的QALYs最高,为1.51286,第二低的成本为60,519.52美元,是最具成本效益的策略.我们的亚组水平分析得出的结果与基本情况分析一致。敏感性分析结果证实了模型的有效性和可靠性。
■在中国,与单纯化疗相比,一线ICIs+化疗的组合不被认为具有成本效益.然而,当这些一线免疫化疗策略相互比较时,一线serplulimab联合化疗在成本效益方面始终显示出优越性.降低每4.5mg/kgserplulimab的成本将是使一线serplulimab加化疗更容易获得和具有成本效益的现实步骤。
UNASSIGNED: To determine the cost-effectiveness of imported immune checkpoint inhibitors (
ICIs) such as atezolizumab and durvalumab, and domestic
ICIs like serplulimab and adebrelimab, in combination with chemotherapy for extensive-stage small cell lung cancer (ES-SCLC) in China.
UNASSIGNED: Using a 21-day cycle length and a 20-year time horizon, a Markov model was established to compare the clinical and economic outcomes of five first-line
ICIs plus chemotherapy versus chemotherapy alone, as well as against each other, from the perspective of the Chinese healthcare system. Transition probabilities were estimated by combining the results of the CAPSTONE-1 trial and a published network meta-analysis. Cost and health state utilities were collected from multiple sources. Both cost and effectiveness outcomes were discounted at a rate of 5% annually. The primary model output was incremental cost-effectiveness ratios (ICERs). A series of sensitivity analyses were preformed to assess the robustness of the model.
UNASSIGNED: In the base-case analysis, the addition of first-line
ICIs to chemotherapy resulted in the ICERs ranged from $80,425.31/QALY to $812,415.46/QALY, which exceeded the willing-to-pay threshold set for the model. When comparing these first-line immunochemotherapy strategies, serplulimab plus chemotherapy had the highest QALYs of 1.51286 and the second lowest costs of $60,519.52, making it is the most cost-effective strategy. Our subgroup-level analysis yielded results that are consistent with the base-case analysis. The sensitivity analysis results confirmed the validity and reliability of the model.
UNASSIGNED: In China, the combination of fist-line
ICIs plus chemotherapy were not considered cost-effective when compared to chemotherapy alone. However, when these fist-line immunochemotherapy strategies were compared with each other, first-line serplulimab plus chemotherapy consistently demonstrated superiority in terms of cost-effectiveness. Reducing the cost of serplulimab per 4.5 mg/kg would be a realistic step towards making first-line serplulimab plus chemotherapy more accessible and cost-effective.