■最近,几种新的程序性细胞死亡蛋白1(PD-1)抑制剂已被批准用于二线治疗晚期或转移性食管鳞状细胞癌(OSCC),包括camrelizumab,Nivolumab,pembrolizumab,sintilimab和tislelizumab。然而,最佳治疗方案仍然不明确.
■本研究的目的是调查疗效,从中国医疗系统的角度确定最佳治疗方法的安全性和经济性。
■系统回顾和经济评价。
■利用PubMed进行了系统评价,WebofScience,科克伦图书馆,Embase和Scopus数据库,以确定合格的研究,直到2023年8月31日。主要结果是无进展生存期(PFS),总生存期(OS)和不良事件(AE)。我们还根据五项临床试验以3周的间隔开发了分区生存模型,以预测长期成本。各种治疗方案的质量调整寿命年(QALYs)和增量成本效益比。直接医疗费用和效用值从公共药品招标数据库获得,临床试验或已发表文献。通过单向和概率敏感性分析确定模型内的参数不确定性。
■分析中纳入了5项涉及2837名患者的随机对照试验。与其他检查的治疗方法相比,camrelizumab提供了最佳的PFS益处[风险比(HR):0.69,95%置信区间(CI):0.56-0.86],和派博利珠单抗提供了最好的OS益处(HR:0.55,95%CI:0.37-0.82)。与其他免疫治疗方案相比,Nivolumab引起的治疗相关AE(HR:0.10,95%CI:0.05-0.20)和3-5级AE(HR:0.13,95%CI:0.08-0.21)的发生率相对较低。在经济评价中,平均10年费用为5,433.86美元(化疗)至50,617.95美元(纳武单抗),平均QALY为0.55美元(化疗)至0.82美元(卡利单抗).由于优势,Pembrolizumab被淘汰。在剩下的策略中,当2022年支付意愿阈值为人均GDP的1、2和3倍时,sintilimab,tislelizumab和camrelizumab是最具成本效益的治疗选择,分别。
■Sintilimab可能是中国晚期OSCC二线治疗的最佳治疗选择,其次是tislelizumab和camrelizumab.
■本研究已在PROSPERO数据库上注册,注册号为CRD42023495204。
免疫检查点抑制剂与化疗作为晚期食管鳞状细胞癌二线治疗的比较:系统评价和经济学评价背景:本研究的目的是探讨疗效,从中国医疗系统的角度确定最佳治疗方法的安全性和经济性。
方法:利用PubMed进行了系统评价,WebofScience,科克伦图书馆,Embase,和Scopus数据库,以确定合格的研究,直到2023年8月31日。主要结果是无进展生存期(PFS),总生存期(OS),和不良事件(AE)。我们还根据5项临床试验以3周的间隔开发了分区生存模型,以预测长期成本。各种治疗方案的质量调整寿命年(QALYs)和增量成本效益比(ICER)。从公共药品招标数据库获得直接医疗费用和效用值,临床试验或已发表文献。通过单向和概率敏感性分析确定模型内的参数不确定性。
结果:与其他检查的治疗方法相比,camrelizumab提供了最好的PFS益处(HR:0.69,95%CI:0.56-0.86),和派博利珠单抗提供了最好的OS益处(HR:0.55,95%CI:0.37-0.82)。与其他免疫治疗方案相比,Nivolumab引起的治疗相关AE(HR:0.10,95%CI:0.05-0.20)和3-5级AE(HR:0.13,95%CI:0.08-0.21)的发生率相对较低。在经济评价中,平均10年费用为5,433.86美元(化疗)至50,617.95美元(纳武单抗),平均QALY为0.55美元(化疗)至0.82美元(卡利单抗).由于优势,Pembrolizumab被淘汰。在剩下的策略中,当2022年支付意愿阈值为人均GDP的1、2和3倍时,sintilimab,tislelizumab,卡姆瑞珠单抗是最具成本效益的治疗选择,分别。
结论:Sindilimab可能是中国晚期ESCC二线治疗的最佳治疗选择,其次是tislelizumab和camrelizumab.
UNASSIGNED: Recently, several novel programmed cell death protein 1 (PD-1) inhibitors have been approved for second-line treating advanced or metastatic oesophageal squamous cell carcinoma (OSCC), including camrelizumab, nivolumab, pembrolizumab, sintilimab and tislelizumab. However, the optimal treatment regimen remained ambiguous.
UNASSIGNED: The purpose of this study was to investigate the efficacy, safety and economy of available PD-1 inhibitors to determine the optimal treatment from the Chinese healthcare system perspective.
UNASSIGNED: A systematic review and economic evaluation.
UNASSIGNED: A systematic review was undertaken utilizing PubMed, Web of Science, Cochrane Library, Embase and Scopus databases to identify eligible studies until 31 August 2023. Primary outcomes were progression-free survival (PFS), overall survival (OS) and adverse events (AEs). We also developed a partitioned survival model at 3-week intervals based on five clinical trials to predict long-term costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios for various treatment options. Direct medical costs and utility values were obtained from public drug bidding databases, clinical trials or published literature. The parameter uncertainties within the model were determined via one-way and probabilistic sensitivity analyses.
UNASSIGNED: Five randomized controlled trials involving 2837 patients were included in the analysis. Compared with other treatments examined, camrelizumab provided the best PFS benefits [hazard ratio (HR): 0.69, 95% confidence interval (CI): 0.56-0.86], and pembrolizumab provided the best OS benefits (HR: 0.55, 95% CI: 0.37-0.82). Nivolumab caused a relatively lower incidence of treatment-related AEs (HR: 0.10, 95% CI: 0.05-0.20) and grade 3-5 AEs (HR: 0.13, 95% CI: 0.08-0.21) than other immunotherapy regimens. In the economic evaluation, average 10-year costs ranged from $5,433.86 (chemotherapy) to $50,617.95 (nivolumab) and mean QALYs ranged from 0.55 (chemotherapy) to 0.82 (camrelizumab). Pembrolizumab was eliminated because of dominance. Of the remaining strategies, when the willingness-to-pay thresholds were 1, 2 and 3 times GDP per capita in 2022, sintilimab, tislelizumab and camrelizumab were the most cost-effective treatment options, respectively.
UNASSIGNED: Sintilimab might be the optimal treatment alternative for second-line therapy of advanced OSCC in China, followed by tislelizumab and camrelizumab.
UNASSIGNED: This study has been registered on the PROSPERO database with the registration number CRD42023495204.
Immune checkpoint inhibitors versus chemotherapy as second-line therapy for advanced esophageal squamous cell carcinoma: a systematic review and economic evaluation Background: The purpose of this study was to investigate the efficacy, safety and economy of available PD-1 inhibitors to determine the optimal treatment from the Chinese healthcare system perspective.
METHODS: A systematic review was undertaken utilizing PubMed, Web of Science, Cochrane Library, Embase, and Scopus databases to identify eligible studies until August 31, 2023. Primary outcomes were progression-free survival (PFS), overall survival (OS), and adverse events (AEs). We also developed a partitioned survival model at 3-week intervals based on 5 clinical trials to predict long-term costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) for various treatment options. Direct medical costs and utility values were obtained from public drug bidding database, clinical trials or published literatures. The parameter uncertainties within the model were determined via one-way and probabilistic sensitivity analyses.
RESULTS: Compared with other treatments examined, camrelizumab provided the best PFS benefits (HR: 0.69, 95% CI: 0.56-0.86), and pembrolizumab provided the best OS benefits (HR: 0.55, 95% CI: 0.37-0.82). Nivolumab caused a relatively lower incidence of treatment-related AEs (HR: 0.10, 95% CI: 0.05-0.20) and grade 3-5 AEs (HR: 0.13, 95% CI: 0.08-0.21) than other immunotherapy regimens. In the economic evaluation, average 10-year costs ranged from $5,433.86 (chemotherapy) to $50,617.95 (nivolumab) and mean QALYs ranged from 0.55 (chemotherapy) to 0.82 (camrelizumab). Pembrolizumab was eliminated because of dominance. Of the remaining strategies, when the willingness-to-pay thresholds were 1, 2, and 3 times GDP per capita in 2022, sintilimab, tislelizumab, and camrelizumab were the most cost-effective treatment options, respectively.
CONCLUSIONS: Sintilimab might be the optimal treatment alternative for second-line therapy of advanced ESCC in China, followed by tislelizumab and camrelizumab.