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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 |
| 阅读数： | 31 次 |
| 本月下载数： | 6 次 |
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