非鳞非小细胞肺癌患者二线化疗方案的成本-效果分析

doi:10.5246/jcps.2020.08.051

摘要/Abstract

摘要：

肺癌是全球发病率最高的一类癌症, 也是癌症相关死亡的最主要原因。这项研究分析了吉西他滨、培美曲塞和多西他赛用于中国晚期非鳞状非小细胞肺癌患者二线化疗的成本效果性。本研究建立了三状态的Markov模型, 包括无进展生存状态、进展生存状态和死亡状态, 以模拟非鳞非小细胞肺癌6年的疾病转归。采用敏感性分析评估模型的稳定性。模型基线分析结果显示, 以中国2018年的3倍人均国民生产总值($29 383)为意愿支付阈值时, 吉西他滨、培美曲塞和多西他赛用于非鳞非小细胞肺癌二线化疗方案患者所获得的质量调整生命年分别为0.233年、0.417年和0.272年, 相应的总费用为5321.02美元、12 143.94美元和9479.42美元。相较于吉西他滨, 培美曲塞和多西他赛每增加一个质量调整生命年, 相应的增量成本效果比将增加37 081.09美元和106 625.64美元, 均超过了意愿支付阈值。一元敏感性分析表明, 吉西他滨在疾病进展状态的效用值是对模型影响最大的参数。

关键词: 成本-效果分析, 二线化疗, 非鳞非小细胞肺癌, 吉西他滨, 培美曲塞, 多西他赛

Abstract:

Lung cancer is the most widespread type of cancer and the primary cause of cancer-related death in the world. In this study, we aimed to analyze the cost-effectiveness of second-line chemotherapy strategies based on gemcitabine, pemetrexed, and docetaxel for advanced non-squamous non-small cell lung cancer patients in China.A Markov model based on three states, progression-free survival, progressed survival and death, was constructed to simulate the progression of the disease in a 6-year horizon. Sensitivity analysis was performed to evaluate the robustness of the model. The primary outcome of the model was the incremental cost-effectiveness ratio at a willingness-to-pay threshold of 3× per capita GDP of China in 2018 ($29 383). The baseline model results showed that the quality-adjusted life years over the course of the disease associated with second-line chemotherapy strategies were 0.233, 0.417 and 0.272 for gemcitabine, pemetrexed and docetaxel, respectively, and the corresponding total costs were $5321.02, $12 143.94, and $9479.42. Gemcitabine, pemetrexed and docetaxel resulted in the incremental cost-effectiveness ratios of $37 081.09 and $106 625.64 per quality-adjusted life year gained. The incremental cost-effectiveness ratio of pemetrexed and docetaxel compared with gemcitabine exceeded the willingness-to-pay threshold. One-way sensitivity analysis showed that the utility value of gemcitabine in the progressed survival state was the most inﬂuential parameter.

Key words: Cost-effectiveness analysis, Second-line chemotherapy, Non-squamous non-small cell lung cancer, Gemcitabine, Pemetrexed, Docetaxel

中图分类号:

R956

Supporting:

林珅, 饶欣, 李逸元, 翁秀华, 王长连. 非鳞非小细胞肺癌患者二线化疗方案的成本-效果分析[J]. 中国药学(英文版), 2020, 29(8): 542-553.

Shen Lin, Xin Rao, Yiyuan Li, Xiuhua Weng, Changlian Wang. Cost-effectiveness analysis of second-line chemotherapy strategies for patients with advanced non-squamous non-small cell lung cancer[J]. Journal of Chinese Pharmaceutical Sciences, 2020, 29(8): 542-553.

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