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纳武利尤单抗二线治疗转移性肾透明细胞癌的成本-效果分析
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| 篇名： | 纳武利尤单抗二线治疗转移性肾透明细胞癌的成本-效果分析 |
| TITLE： | Cost-effectiveness analysis of nivolumab in the second-line treatment of metastatic clear cell renal cell carcinoma |
| 摘要： | 目的 评价纳武利尤单抗对比依维莫司二线治疗转移性肾透明细胞癌的经济性。方法从我国卫生体系角度出发，采用三状态分区生存模型对两种方案进行成本-效果分析，临床参数来自更新后的CheckMate025研究，成本和健康效用来自相关网站和已发表的文献。模型循环周期为2周，研究时限为患者终生。采用敏感性分析验证研究结果的稳健性；并探讨两种方案在模型模拟时间为80个月和有慈善赠药方案两种情境下的经济性。结果基础分析结果显示，与依维莫司方案相比，纳武利尤单抗方案的增量成本-效果比（ICER）值为586982.60元/质量调整生命年（QALY），远高于3倍2020年我国人均国内生产总值（GDP）。单因素敏感性分析结果显示，对经济性评价结果影响较大的3个参数依次为纳武利尤单抗单价、纳武利尤单抗组患者疾病进展状态的效用值和依维莫司组患者疾病进展状态的效用值。概率敏感性分析结果验证了基础分析结果的稳健性。情境分析结果显示，当模型模拟时间为80个月时，纳武利尤单抗方案的ICER值为417204.52元/QALY；当考虑针对低收入人群的纳武利尤单抗慈善赠药方案时，ICER值为124988.58元/QALY。结论在1～3倍2020年我国人均GDP的阈值下，相比于依维莫司方案，纳武利尤单抗方案用于二线治疗转移性肾透明细胞癌不具有经济性；当考虑针对低收入人群的慈善赠药方案时，纳武利尤单抗方案可能是经济的。 |
| ABSTRACT： | OBJECTIVE To ev aluate the economical efficiency of nivolumab versus everolimus in the second-line treatment of metastatic clear cell renal cell carcinoma. METHODS From the perspective of China ’s health system ，cost-effectiveness analysis of the two therapies was carried out by developing a three-state partitioned survival model. The clinical parameters were from the updated CheckMate 025 study，and the cost and health utility were from relevant websites and published literatures. The model adopted a 2-week cycle and a lifetime research time. The robustness of the results was verified by sensitivity analysis. The economical efficiency of two therapy schemes were evaluated in the scenario of model simulation time of 80 months and charitable drug donation scheme. RESULTS The results of basic analysis showed that compared with everolimus ，the incremental cost-effectiveness ratio （ICER）of nivolumab was 586 982.60 yuan/quality-adjusted life year （QALY），which was far higher than 3 times of China ’s per capita gross domestic product （GDP）in 2020. The results of single-factor sensitivity analysis showed that the 3 parameters that had the greatest impact on the economic evaluation results were the cost of nivolumab ，the utility value of nivolumab group and everolimus group in progressive disease state. The results of probability sensitivity analysis verified the robustness of the basic analysis results. Results of scenario analysis showed that in the first scenario analysis ，in which model simulation time lasted for 80 months，ICER of nivolumab was 417 204.52 yuan/QALY；in the second scenario analysis ，in which nivolumab charitable drug donation program for low-income people was considered ，ICER of nivolumab was 124 988.58 yuan/QALY. CONCLUSIONS Under the threshold of 1-3 times of China ’s per capita GDP in 2020，compared with everolimus ，it is not economical to use nivolumab as the second-line treatment for metastatic clear cell renal cell carcinoma ； nivolumab is economical when considering its charitable drug donation program for low-income people. |
| 期刊： | 2022年第33卷第10期 |
| 作者： | 曹潆丹，石丰豪，孟蕊，陈平钰，费正洋，张雪珂，马爱霞 |
| AUTHORS： | CAO Yingdan，SHI Fenghao，MENG Rui，CHEN Pingyu，FEI Zhengyang，ZHANG Xueke，MA Aixia |
| 关键字： | 纳武利尤单抗；转移性肾透明细胞癌；依维莫司；分区生存模型；成本-效果分析 |
| KEYWORDS： | nivolumab；metastatic clear cell renal cell carcinoma ；everolimus；partitioned survival model ；cost-effectiveness |
| 阅读数： | 218 次 |
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