聚乙二醇脂质体阿霉素联合化疗方案治疗复发性卵巢癌的成本-效果分析

目的：评价聚乙二醇脂质体阿霉素+贝伐珠单抗+卡铂（CD-BEV）化疗方案与吉西他滨+贝伐珠单抗+卡铂（CG-BEV）化疗方案治疗复发性卵巢癌的经济性。方法：基于已发表的一项Ⅲ期临床随机对照试验，根据疾病发展过程建立Markov模型，将患者的疾病发展过程分为无进展状态、进展状态和死亡状态，对CD-BEV方案与CG-BEV方案进行成本-效果分析，并对模型结果的稳定性进行单因素敏感性分析和概率敏感性分析。结果：根据Markov模型分析结果，CD-BEV方案对比CG-BEV方案的增量成本-效果比（ICER）值为565 409.69元/QALY，高于中国居民意愿支付阈值（217 341.00元/QALY）。单因素敏感性分析结果显示：聚乙醇脂质体阿霉素成本、无进展状态效用值、进展状态效用值对成本-效果分析结果的影响最大；概率敏感性分析结果显示：ICER值大于WTP（3倍GDP）的概率为100%。结论：与CG-BEV方案相比，CD-BEV方案治疗复发性卵巢癌不具有成本-效果优势。

Cost-effectiveness analysis of pegylated liposomal doxorubicin combined with chemotherapy in the treatment of recurrent ovarian cancer

OBJECTIVE To explore the cost-effectiveness of carboplatin-pegylated liposomal doxorubicin-bevacizumab and carboplatin-gemcitabine-bevacizumab in the treatment of recurrent ovarian cancer.METHODS Based upon a published phase Ⅲ randomized clinical controlled trial, Markov model was established according to disease development process.The disease development process of patients with ovarian cancer was divided into non-progressive free survival, disease progression and death states.Cost-effectiveness analysis was performed between CD-BEV and CG-BEV and uncertainty of results was evaluated with single factor sensitivity and probability sensitivity analyses.RESULTS According to the results of Markov model, the ICER value in CD-BEV versus CG-BEV was 565 409.69 yuan/quality-adjusted life year(QALY) and it was higher than the domestic willingness-to-pay(WTP) threshold(217 341.00 yuan/QALY) without cost-effectiveness.One-way sensitivity analysis showed that cost of PLD, utility of PFS and utility of PD were the most predominant parameters in the model;and the results of probability sensitivity analysis indicated that the probability of ICER value higher than WTP(3 folds GDP) was 100%.CONCLUSION As compared with CG-BEV, CD-BEV offers no cost-effectiveness edge in the treatment of recurrent ovarian cancer.