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HER-2阳性晚期胃癌多种序贯治疗方案的成本-效用分析
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| 篇名： | HER-2阳性晚期胃癌多种序贯治疗方案的成本-效用分析 |
| TITLE： | Cost-utility analysis of multiple sequential treatment regimens for HER-2 positive advanced gastric cancer |
| 摘要： | 目的 从中国卫生体系的角度，评估不同序贯治疗方案治疗人表皮生长因子受体2（HER-2）阳性晚期胃癌的经济性。方法从ToGA、WJOG4007和RAINBOW-Asia试验中获取生存数据，采用网状Meta分析进行调整。构建四状态Markov模型评估6种治疗序列的经济性，模拟时限为终身，循环周期为4周（28d），模型的主要输出参数包括总成本、质量调整生命年（QALY）和增量成本-效果比（ICER）。通过敏感性分析检验基础分析结果的稳健性，并对曲妥珠单抗进行降价情境分析。结果相比化疗序贯紫杉醇，曲妥珠单抗联合化疗序贯紫杉醇或伊立替康或雷莫西尤单抗联合紫杉醇的ICER分别为349845.25、772410.64、2510470.39元/QALY，均超过3倍我国2023年人均国内生产总值（GDP）作为的意愿支付（WTP）阈值（268074元/QALY），显示化疗序贯紫杉醇方案为最优治疗方案。敏感性分析结果证明了基础分析结果的稳健性。情境分析结果表明，当曲妥珠单抗降价幅度大于20%时，在本研究的WTP阈值下，曲妥珠单抗联合化疗序贯紫杉醇方案开始具有经济性。结论在以3倍我国2023年人均GDP作为WTP阈值时，化疗序贯紫杉醇是治疗HER-2阳性晚期胃癌的最优方案，曲妥珠单抗联合化疗序贯紫杉醇为次优方案。随着医保政策优化力度的增大，曲妥珠单抗联合化疗序贯紫杉醇有望成为最具经济性的治疗方案。 |
| ABSTRACT： | OBJECTIVE To evaluate the cost-effectiveness of different sequential treatment regimens for human epidermal growth factor receptor 2 （HER-2）-positive advanced gastric cancer from the perspective of the Chinese health system. METHODS Survival data were obtained from the ToGA， WJOG 4007 and RAINBOW-Asia trials， and adjusted using network meta-analysis. A four-state Markov model was constructed to evaluate the cost-effectiveness of six treatment sequences， with a lifetime simulation horizon and a cycle period of 4 weeks （28 d）， and the main output parameters of the model included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analysis was conducted to test the robustness of the basic analysis results， and a price reduction scenario analysis for trastuzumab was performed. RESULTS Compared with chemotherapy sequentially treated with paclitaxel， the ICER of trastuzumab combined with chemotherapy sequentially treated with paclitaxel， or irinotecan， or ramucirumab plus paclitaxel were 349 845.25， 772 410.64， and 2 510 470.39 yuan/QALY， respectively， all exceeding three times China’s 2023 per capita gross domestic product （GDP） （268 074 yuan/QALY） as the willingness-to-pay （WTP） threshold. This indicated that chemotherapy sequential paclitaxel was the optimal treatment regimen. The sensitivity analysis confirmed the robustness of the basic analysis. The scenario analysis showed that when trastuzumab was reduced by more than 20%， trastuzumab combined with chemotherapy sequentially treated with paclitaxel became cost-effective under this study’s WTP threshold. CONCLUSIONS When using three times China’s 2023 per capita GDP as the WTP threshold， chemotherapy sequentially treated with paclitaxel is the optimal regimen for HER-2 positive advanced gastric cancer， with trastuzumab combined with chemotherapy sequentially treated with paclitaxel as the second best option. With enhanced medical insurance optimization， trastuzumab combined with chemotherapy sequentially treated with paclitaxel is expected to become the most cost-effective treatment regimen. |
| 期刊： | 2025年第36卷第13期 |
| 作者： | 刘娜娜；管欣；胡霞 |
| AUTHORS： | LIU Nana，GUAN Xin，HU Xia |
| 关键字： | HER-2阳性晚期胃癌；化疗；紫杉醇；曲妥珠单抗；序贯治疗；成本-效用分析；网状Meta分析；Markov模型 |
| KEYWORDS： | HER-2 positive advanced gastric cancer； chemotherapy； paclitaxel； trastuzumab； sequential therapy； cost-utility |
| 阅读数： | 3 次 |
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