卡瑞利珠单抗联合卡铂和培美曲塞一线治疗晚期非鳞状非小细胞肺癌患者的成本-效果分析

目的 在2020年新版医保目录执行后癌症免疫治疗类药品降价的背景下，从卫生体系的角度，研究获批一线治疗晚期非鳞状非小细胞肺癌适应证的卡瑞利珠单抗联合化疗药品（卡铂和培美曲塞）与化疗药品单独使用的成本-效果，评估降价后药品的经济性。方法 基于一项在中国患者人群内开展的临床试验（CameL），通过建立分区生存模型，评价卡瑞利珠单抗联合用药相对于单纯使用化疗药品在治疗时所产生的增量成本效果，并对主要参数进行确定敏感性分析和概率敏感性分析。结果 基础分析显示卡瑞利珠单抗联合化疗药品相对于单纯使用化疗药品的增量成本效果比为164 271.19元/QALY，降至3倍中国人均GDP（217 341元）的意愿支付阈值以内。确定敏感性分析显示，与卡瑞利珠单抗联合使用的化疗药物的成本是增量成本效果比的主要影响因素之一；概率敏感性分析显示，当意愿支付阈值为3倍人均GDP时，卡瑞利珠单抗联合用药相对于单纯使用化疗药品具有成本效果的概率为82.0%。结论 对于晚期非鳞状非小细胞肺癌的患者，一线使用卡瑞利珠单抗联合化疗药品（卡铂和培美曲塞）具有成本效果优势。

Cost-effectiveness of Camrelizumab Plus Carboplatin and Pemetrexed in the First-line Treatment of Patients with Advanced Non-squamous Non-small-cell Lung Cancer

OBJECTIVE To evaluate the cost-effectiveness of camrelizumab plus carboplatin and pemetrexed versus chemotherapy alone in the first-line treatment of patients with advanced non-squamous non-small-cell lung cancer from the perspective of the health care system in the context of new national basic medical care insurance medicine catalogue in 2020. METHODS Based on a clinical trial conducted in Chinese patients(CameL), the partitioned survival model was established to analyze the incremental cost-effectiveness in experimental group(camrelizumab plus carboplatin and pemetrexed), compared with control group chemotherapy alone. Deterministic sensitivity analysis and probabilistic sensitivity analysis were performed. RESULTS The basic analysis showed that the incremental cost-effectiveness ratio of experimental group versus control group was 164 271.19 yuan/quality-adjusted life year(QALY), which was lower than the willingness to pay threshold of three times per capita GDP of China(217 341 yuan). Deterministic sensitivity analysis implied that the chemotherapy drugs used in the experimental group was one of the main influencing factors of the incremental cost-effectiveness ratio. Probabilistic sensitivity analysis showed that the cost-effectiveness probability for the experimental group was 82.0%. CONCLUSION For patients with advanced non-squamous non-small-cell lung cancer, camrelizumab as first-line treatment is cost-effectiveness.