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帕妥珠单抗联合曲妥珠单抗、多西他赛一线治疗HER2阳性转移性乳腺癌的成本-效用分析
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| 篇名： | 帕妥珠单抗联合曲妥珠单抗、多西他赛一线治疗HER2阳性转移性乳腺癌的成本-效用分析 |
| TITLE： | Cost-utility analysis of pertuzumab combined with trastuzumab and docetaxel in first-line treatment of HER 2- positive metastatic breast cancer |
| 摘要： | 目的 评价帕妥珠单抗联合曲妥珠单抗、多西他赛（PTD）方案相比曲妥珠单抗联合多西他赛（TD）方案一线治疗人表皮生长因子受体2（HER2）阳性转移性乳腺癌的经济性。方法从我国卫生体系角度出发，利用CLEOPATRA临床试验披露的生存数据和相关文献数据构建分区生存模型，模型模拟时限设为20年，循环周期为3周，贴现率为5％。模型的产出指标包括两种治疗方案的成本及质量调整生命年（QALYs）。意愿支付（WTP）阈值设为2020年我国1～3倍人均国内生产总值（GDP），即72000～216000元/QALY。采用单因素敏感性分析及概率敏感性分析评价模型参数变化对结果稳健性的影响。结果基础分析结果显示，在20年的模拟时限内，PTD方案较TD方案可带来更高的健康获益（3.28QALYsvs.2.50QALYs），但总成本更高（1219376.83元vs.784007.84元）；与TD方案相比，PTD方案的增量成本-效果比为554625.46元/QALY，超过WTP阈值。单因素敏感性分析结果显示，疾病无进展生存状态的效用值对结果的影响最大。概率敏感性分析结果显示，使用我国2020年3倍人均GDP作为WTP阈值时，PTD方案具有经济性的概率为1％；当WTP阈值升至550000元/QALY时，PTD方案具有经济性的概率可达50％。结论与TD方案相比，PTD方案一线治疗HER2阳性转移性乳腺癌不具有经济性。 |
| ABSTRACT： | OBJECTIVE To evaluate the economics of pertuzumab combined with trastuzumab and docetaxel（PTD）regimenversus trastuzumab combined with docetaxel（TD）regimen in first-line treatment of human epidermal growth factor receptor 2 （HER2）-positive metastatic breast cancer. METHODS From the perspective of Chinese healthcare system，the partitioned survivalmodel was constructed by using survival data disclosed in the CLEOPATRA clinical trial and relevant literature data. The time horizon of the model was set as 20 years and the cycle length of the model was 3 weeks，and discount rate was 5％. The output indicators of the model included the cost and quality-adjusted life years（QALYs）of the two treatment regimens. The reshold of willingness-to-pay（WTP）was set as 1-3 times per capita gross domestic product（GDP）in China in 2020，i. e. 72 000-216 000 yuan/QALY. One-way sensitivity analysis and probabilistic sensitivity nalysis were used to evaluate the influence of model parameter changes on the robustness of the results. RESULTS The results of base-case analysis showed that within the horizon of 20 years，PTD regimen could bring more health benefit than TD regimen（3.28 QALYs vs. 2.50 QALYs），but the total costs was higher（1 219 376.83 yuan vs. 784 007.84 yuan）. Compared with TD regimen，the incremental cost-effectiveness ratio of PTD regimen was 554 625.46 yuan/QALY，which exceeded threshold of WTP. The results of one-way nsitivity analysis showed that the utility of progression-free survival state hadthe greatest impact on the results；the results of probability sensitivity analysis showed that the probability of PTD regimen considered as to be cost-effective was 1％ when using the 3 times per capita GDP in China in 2020 as the threshold of WTP；when the threshold of WTP increased to 550 000 yuan/QALY，the probability of PTD regimen considered as to be cost-effective would reach to 50％. CONCLUSIONS Compared with TD regimen，PTD regimen is unlikely to be cost-effective in first-line treatment of HER2-positive metastatic breast cancer. |
| 期刊： | 2022年第33卷第04期 |
| 作者： | 贾才凤，张森，徐浩，李赛男，王明霞 |
| AUTHORS： | JIA Caifeng ，ZHANG Sen，XU Hao，LI Sainan ，WANG Mingxia |
| 关键字： | 帕妥珠单抗；曲妥珠单抗；多西他赛；人表皮生长因子受体2阳性转移性乳腺癌；成本-效用分析 |
| KEYWORDS： | pertuzumab；trastuzumab；docetaxel；human epidermal growth factor receptor 2-positive metastatic breast cancer ； |
| 阅读数： | 421 次 |
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