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加用达雷妥尤单抗治疗不适合干细胞移植的新诊断多发性骨髓瘤的药物经济学评价
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| 篇名： | 加用达雷妥尤单抗治疗不适合干细胞移植的新诊断多发性骨髓瘤的药物经济学评价 |
| TITLE： | Pharmacoeconomic evaluation of additional use of daratumumab in the treatment of transplant-ineligible newly diagnosed multiple myeloma |
| 摘要： | 目的 评价达雷妥尤单抗联合来那度胺和地塞米松（D-Rd）方案对比单用来那度胺和地塞米松（Rd）方案治疗不适合干细胞移植的新诊断多发性骨髓瘤（TNE-NDMM）的经济性。方法从我国卫生体系角度出发，利用已发表的MAIA试验数据和相关文献数据建立具有无进展生存、疾病进展和死亡3种健康状态的分区生存模型，以28d为模型周期，模拟时限为20年；以质量调整生命年（QALY）作为产出指标计算增量成本-效果比（ICER），并对关键参数进行敏感性分析。结果基础分析结果显示，D-Rd方案相较Rd方案的ICER为2719038.08元/QALY，远大于3倍2021年我国人均国内生产总值（GDP，即242928元）。单因素敏感性分析结果显示，成本贴现率、无进展生存期效用状态、效用贴现率、达雷妥尤单抗成本和来那度胺成本对ICER的影响较大。概率敏感性分析结果显示，当意愿支付阈值（WTP）为0～1200000元时，D-Rd方案具有经济性优势的概率始终为0。结论在以3倍2021年我国人均GDP作为WTP的情况下，D-Rd方案相比Rd方案治疗TNE-NDMM不具有成本-效果优势。 |
| ABSTRACT： | OBJECTIVE To evaluate the econ omical efficiency of daratumumab combined with lenalidomide and dexamethasone （D-Rd） regimen versus lenalidomide and dexamethasone （Rd） regimen alone in the treatment of transplant- ineligible newly diagnosed multiple myeloma （TNE-NDMM）. METHODS From the perspective of China ’s health system ，a partitioned survival model with three health states of progression free survival ，disease progression and death was established by using the published MAIA test data and relevant literature data. The model cycle was 28 days and the simulation time limit was 20 years. The incremental cost-effectiveness ratio （ICER）was calculated using quality-adjusted life years （QALY）as the output index. Sensitivity analysis was performed for key parameters. RESULTS The results of basic analysis showed that the ICER of D-Rd regimen versus Rd regimen was 2 719 038.08 yuan/QALY，far exceeding 3 times of GDP per capita in 2021（242 928 yuan）. The results of single factor sensitivity analysis showed that cost discount rate ，progression-free survival utility value ，utility discount rate，the cost of daratumumab and lenalidomide had a greater impact on ICER. Probabilistic sensitivity analysis suggested that the probability of economic advantage of D-Rd regimen was always 0 within the WTP range of 0-1 200 000 yuan. CONCLUSIONS Compared with Rd regimen ，D-Rd regimen has no cost-effectiveness advantage for the treatment of TNE-NDMM under the WTP of 3 times GDP per capita of China . |
| 期刊： | 2022年第33卷第11期 |
| 作者： | 贾琳琳，胡梦雪，高红婷，侯艳红 |
| AUTHORS： | JIA Linlin，HU Mengxue ，GAO Hongting ，HOU Yanhong |
| 关键字： | 达雷妥尤单抗；多发性骨髓瘤；分区生存模型；药物经济学 |
| KEYWORDS： | daratumumab；multiple myeloma ；partitioned survival model ；pharmacoeconomics |
| 阅读数： | 180 次 |
| 本月下载数： | 9 次 |
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