克唑替尼一线治疗ALK阳性非小细胞肺癌的成本-效果分析

目的:比较克唑替尼和培美曲塞联合顺铂一线治疗间变淋巴瘤激酶(ALK)阳性非小细胞肺癌(NSCLC)的成本-效果。方法:从医疗保健系统角度出发,构建三状态Markov模型模拟疾病病程,根据Ⅲ期临床试验数据获得各状态之间的转移概率,从已发表文献获得成本数据,效果指标为质量调整生命年(QALY);采用成本-效果分析法比较两方案的经济性,并进行敏感性分析。结果:克唑替尼组和培美曲塞联合顺铂化疗组的两年总成本分别为554322.4元和293622.8元,分别获得1.48 QALYs和1.33 QALYs,克唑替尼组的收益较化疗组更高,但成本也高于化疗组,增量成本-效果比(ICER)为1698291元/QALY,高于支付意愿阈值161805元(3倍人均GDP)。结论:短期分析结果提示,与培美曲塞联合顺铂化疗相比,克唑替尼治疗ALK阳性晚期NSCLC不具有经济性,克唑替尼组效用值为主要决定因素。

Cost-effectiveness Analysis of Crizotinib in First-line Treatment of ALK-positive Non-small Cell Lung Cancer

Objective:To compare the cost-effectiveness of crizotinib and pemetrexed combined with cisplatin in the treatment of untreated anaplastic lymphoma kinase(ALK)positive non-small cell lung cancer(NSCLC).Methods:From the point of view of payers,a three-state Markov model was constructed to simulate the course of disease,and the transition probability between different states was obtained according to the data from phaseⅢclinical trial.The cost data were obtained from the published data,and the effect index was quality adjusted life year(QALY).The cost-effectiveness analysis method was used to compare the cost-effectiveness of the two schemes,and the sensitivity analysis was carried out.Results:The 2-year total cost of crizotinib group and chemotherapy group was 554322.4 RMB and 293622.8 RMB with 1.48 QALYs and 1.33 QALYs,respectively.The benefit of crizotinib group was higher than that of the chemotherapy group,while the cost was also higher than that of the platinum-containing regimen,and the incremental costeffectiveness ratio(ICER)was 1698291 RMB/QALY,which was higher than the willingness to pay threshold of 161805 RMB(3 times per capita GDP).Conclusion:The results of short-term analysis suggest that crizotinib is not a cost-effective option in the treatment of ALK-positive advanced NSCLC when compared with pemetrexed combined with cisplatin chemotherapy,and the utility value of crizotinib is the main deciding factor.