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    度伐利尤单抗联合化疗治疗广泛期小细胞肺癌的成本-效果分析

    Cost-effectiveness Analysis of Durvalumab Plus Chemotherapy for Extensive-stage Small-Cell Lung Cancer

      摘要
    • 摘要:
      目的  从中国卫生体系角度出发分析度伐利尤单抗联合化疗治疗广泛期小细胞肺癌(extensive-stage small-cell lung cancer，ES-SCLC)的成本-效果。
      方法 以CASPIAN研究结果为生存数据来源并纳入直接医疗成本建立分区生存模型。采用增量成本-效果比(incremental cost-effectiveness ratio，ICER)作为主要评价指标，通过比较ICER与意愿支付值的大小判断度伐利尤单抗联合方案的成本-效果。通过敏感性分析与情景分析验证结论的稳定性。
      结果 度伐利尤单抗联合化疗方案与单纯化疗方案相比得到的ICER为2 695 436元·(质量调整生命年)−1。疾病进展状态与疾病无进展状态的健康效用值和度伐利尤单抗的成本对ICER影响最大。敏感性分析与情景分析显示结论稳定。
      结论 度伐利尤单抗联合化疗治疗ES-SCLC在中国现有的经济水平下不具有成本-效果优势。

       

      Abstract:
      OBJECTIVE  To analyze the cost-effectiveness of the durvalumab plus chemotherapy regimen for extensive-stage small-cell lung cancer(ES-SCLC) from the perspective of the Chinese healthcare system.
      METHODS A partitioned survival model was constructed using survival data from the CASPIAN study and incorporating direct medical costs. The incremental cost-effectiveness ratio(ICER) served as the primary outcome measure, with the cost-effectiveness of the durvalumab combination regimen determined through comparison of the ICER value against established willingness-to-pay thresholds. Sensitivity and scenario analyses were performed to test the robustness of the conclusions.
      RESULTS  The ICER for the durvalumab plus chemotherapy regimen compared to chemotherapy alone was 2 695 436 yuan·(quality-adjusted life-years)−1. The progressive disease and progression-free survival phases, along with the cost of durvalumab, had the greatest impact on the ICER. Both sensitivity and scenario analyses demonstrated the stability of the conclusions across various parameters.
      CONCLUSION Durvalumab in combination with chemotherapy is not cost-effective for ES-SCLC treatment under the current economic level in China.

       

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