卡瑞利珠单抗联合化疗对比安慰剂联合化疗一线治疗局部晚期或转移性食管鳞状细胞癌的成本效果分析

目的:从中国卫生服务体系的角度出发,评价卡瑞利珠单抗联合化疗与安慰剂联合化疗一线治疗局部晚期或转移性食管鳞状细胞癌的成本效果。方法:基于一项针对中国局部晚期或转移性食管鳞状细胞癌患者的Ⅲ期随机双盲对照临床试验来构建分区生存模型,模拟患者终身的质量调整生命年和增量成本效果比,并进行单因素敏感性分析和概率敏感性分析来检验模型的不确定性。结果:基础分析结果显示,卡瑞利珠单抗组患者比安慰剂组患者多获得0.162个QALYs的同时,多花费33383.57元,增量成本效果比值为205072.47元/QALY,小于3倍人均GDP;单因素敏感性分析显示对模型最敏感的三个因素分别是PFS效用状态、卡瑞利珠单抗成本和效用贴现率;概率敏感性分析显示,当意愿支付数值大于3倍人均GDP时,卡瑞利珠单抗对比化疗方案为更具成本效果的概率为88.6%。结论:从中国卫生服务体系的角度来看,卡瑞利珠单抗联合化疗对比安慰剂联合化疗一线治疗局部晚期或转移性食管鳞状细胞癌是一种有经济效益的选择。

Cost-effectiveness analysis of carrelizumab combined with chemotherapy versus placebo combined with chemotherapy in the first-line treatment of locally advanced or metastatic esophageal squamous cell carcinoma

OBJECTIVE To evaluate the cost-effectiveness of camrelizumab combined with chemotherapy and placebo combined with chemotherapy in the first-line treatment of locally advanced or metastatic esophageal squamous cell carcinoma from the perspective of China’s health service system.METHODS Based on a phase Ⅲ randomized double-blind controlled clinical trial for patients with locally advanced or metastatic esophageal squamous cell carcinoma in China,a partitioned survival model was constructed to simulate the lifelong quality adjusted life year and incremental cost-effectiveness ratio of patients,and the uncertainty of the model was tested by single factor sensitivity analysis and probability sensitivity analysis.RESULTS The results of basic analysis showed that patients in the camrelizumab group obtained 0.162 QALYs more than those in the placebo group,spent 33 383.57 yuan more,and the incremental cost-effectiveness ratio was 205 072.47 yuan/QALY,which was less than 3 times of per capita GDP;Single factor sensitivity analysis showed that the three most sensitive factors to the model were PFS utility status,camrelizumaband utility discount rate;The probability sensitivity analysis showed that when the willingness to pay value was greater than 3 times of per capita GDP,the probability that camrelizumab was more cost-effective than chemotherapy was 88.6%.CONCLUSION From the perspective of China’s health service system,camrelizumab combined chemotherapy is an economic choice for the first-line treatment of locally advanced or metastatic esophageal squamous cell carcinoma compared with placebo combined chemotherapy.