德曲妥珠单抗对比恩美曲妥珠单抗二线治疗HER2阳性转移性乳腺癌的成本-效用分析
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篇名: | 德曲妥珠单抗对比恩美曲妥珠单抗二线治疗HER2阳性转移性乳腺癌的成本-效用分析 |
TITLE: | Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer |
摘要: | 目的 评估德曲妥珠单抗(T-DXd)对比恩美曲妥珠单抗(T-DM1)二线治疗HER2阳性转移性乳腺癌的经济性,为临床用药方案的选择及医疗卫生决策提供依据。方法基于DESTINY-Breast03试验构建分区生存模型,以3周为循环周期,模拟至患者终身。以质量调整生命年(QALY)作为产出指标并计算增量成本-效果比(ICER),再利用敏感性分析验证基础分析结果的稳健性,以此来比较T-DXd与T-DM1二线治疗HER2阳性转移性乳腺癌的经济性。结果在以3倍我国2022年人均国内生产总值(GDP)为意愿支付阈值(257094元/QALY)的前提下,使用T-DXd方案的患者在获得增量效用(0.69QALYs)的同时也需要支付更多成本,ICER值为1850478.40元/QALY。单因素敏感性分析结果显示,对ICER影响较大的因素有无进展生存期状态效用值、T-DXd价格、成本贴现率等,但这些参数在合理范围内波动均不能使基础分析结果发生翻转。概率敏感性分析结果显示,当WTP的阈值上升为1500400元/QALY时,T-DXd方案具有经济性的概率为50%。情境分析结果也验证了基础分析结果的稳健性。结论在以3倍我国人均GDP为意愿支付阈值的前提下,与T-DM1方案相比,T-DXd二线治疗HER2阳性转移性乳腺癌不具有经济性。 |
ABSTRACT: | OBJECTIVE To evaluate the cost-effectiveness of trastuzumab deruxtecan(T-DXd) versus trastuzumab emtansine (T-DM1) in the second-line treatment of HER2-positive metastatic breast cancer, and to provide a basis for the selection of clinical medication regimen and medical and health decisions. METHODS Based on the clinical trial DESTINY-Breast03, a partitioned survival model was constructed, with a cycle of 3 weeks as the simulation of patients’ lifetime. The incremental cost-effectiveness ratio (ICER) was calculated by using quality-adjusted life years (QALY) as output indicators, and sensitivity analysis was used to verify the robustness of the basic analysis results; the cost-effectiveness of the second-line treatment for HER2-positive metastatic breast cancer was compared between T-DXd and T-DM1. RESULTS Under the premise of taking 3 times China’s per capita gross domestic product (GDP) in 2022 as the willingness-to-pay threshold (257 094 yuan/QALY), the T-DXd group also needed to pay more cost compared with T-DM1 group while obtaining incremental utility (0.69 QALYs), and the ICER value was 1 850 478.40 yuan/QALY. The results of univariate sensitivity analysis showed that progression-free survival state utility value, T-DXd price, cost discount rate were factors that had a great influence on ICER value, but these parameters could not flip the basic analysis results within a reasonable range. In the probability sensitivity analysis, when the threshold of willingness-to-pay rose to 1 500 400 yuan/QALY, the probability of economic activity was 50% in the T-DXd regimen. The results of the scenario analysis also verified the robustness of the original research results. CONCLUSIONS Under the premise of 3 times China’s per capita GDP as the WTP threshold, compared with T-DM1, T-DXd is not cost-effective in the second-line treatment of HER2-positive metastatic breast cancer. |
期刊: | 2024年第35卷第02期 |
作者: | 武亚楠;吴方;侯艳红 |
AUTHORS: | WU Yanan,WU Fang,HOU Yanhong |
关键字: | 德曲妥珠单抗;恩美曲妥珠单抗;HER2阳性转移性乳腺癌;分区生存模型;成本-效用分析 |
KEYWORDS: | trastuzumab deruxtecan; trastuzumab emtansine; HER2-positive metastatic breast cancer; partitioned survival |
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