卡培他滨节拍化疗联合芳香化酶抑制剂一线治疗HR+/HER2－转移性乳腺癌的成本-效用分析-中国药房

卡培他滨节拍化疗联合芳香化酶抑制剂一线治疗HR+/HER2－转移性乳腺癌的成本-效用分析

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篇名：	卡培他滨节拍化疗联合芳香化酶抑制剂一线治疗HR+/HER2－转移性乳腺癌的成本-效用分析
TITLE：	Cost-utility analysis of capecitabine metronomic chemotherapy combined with aromatase inhibitor as first-line treatment for HR+/HER2－ metastatic breast cancer
摘要：	目的评估卡培他滨节拍化疗联合芳香化酶抑制剂（AI）对比单用AI一线治疗激素受体阳性（HR+）/人表皮生长因子受体2阴性（HER2－）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MECCA试验构建分区生存模型，以4周为循环周期，模拟至患者终身；以总成本、质量调整生命年（QALY）和增量成本-效果比（ICER）作为模型产出指标。利用敏感性分析验证基础分析结果的稳健性，并通过情境分析考察了10年、20年、终身研究时限下两种方案的经济性。结果在以1倍我国2024年人均国内生产总值（GDP）为意愿支付阈值（95749元/QALY）的前提下，使用卡培他滨节拍化疗联合AI方案的患者在获得增量效用（0.66QALYs）的同时也需要支付更多的成本，ICER为27684.85元/QALY。单因素敏感性分析结果显示，对ICER值影响较大的因素有成本贴现率、卡培他滨节拍化疗联合AI组药品成本、无进展生存状态效用值、随访成本和后续稳定期治疗成本。概率敏感性分析结果显示，当WTP阈值≥49250元/QALY时，卡培他滨节拍化疗联合AI方案具有经济性的概率为100%。情境分析结果表明，卡培他滨节拍化疗联合AI方案在10年、20年、终身研究时限下均较单用AI方案更具有经济性。结论在以1倍我国2024年人均GDP为意愿支付阈值的前提下，与单用AI方案相比，卡培他滨节拍化疗联合AI方案一线治疗HR+/HER2－转移性乳腺癌更具有经济性。
ABSTRACT：	OBJECTIVE To evaluate the cost-effectiveness of capecitabine metronomic chemotherapy combined with aromatase inhibitor （AI） versus AI monotherapy as first-line treatment for hormone receptor-positive （HR+）/human epidermal growth factor receptor 2-negative （HER2－） metastatic breast cancer， thereby providing evidence-based support for clinical therapeutic decision- making and healthcare policy formulation. METHODS Based on the MECCA trial， a partitioned survival model was constructed using a 4-week cycle length to simulate outcomes over patients’ lifetime. The model outputs included total costs， quality-adjusted life year （QALY）， and incremental cost-effectiveness ratio （ICER）. Sensitivity analyses were performed to validate the robustness of base-case results， while scenario analyses examined the cost-effectiveness of both treatment strategies under 10-year， 20-year， and lifetime time horizons. RESULTS With the willingness-to-pay （WTP） threshold set at 1 times China’s 2024 per capita gross domestic product （GDP）（95 749 yuan/QALY）， patients receiving capecitabine metronomic chemotherapy combined with AI regimen gained incremental utility （0.66 QALYs） while incurring higher costs， with ICER of 27 684.85 yuan/QALY. Results of the one-way sensitivity analysis showed that factors with significant impacts on ICER included the cost discount rate， drug costs of the capecitabine metronomic chemotherapy combined with AI group， utility value in the progression-free survival state， follow-up costs， and treatment costs in the subsequent stablephase. Probabilistic sensitivity analysis indicated that when the WTP threshold ≥49 250 yuan/QALY， the capecitabine metronomic chemotherapy combined with AI regimen had a 100% probability of being cost-effective. Scenario analysis results demonstrated that capecitabine metronomic chemotherapy combined with AI regimen was more cost-effective than the AI alone regimen across 10-year， 20-year， and lifetime study horizons. CONCLUSIONS Under the premise that the WTP threshold is set at 1 times China’s per capita GDP in 2024， capecitabine metronomic chemotherapy combined with AI regimen is more cost-effective than the AI alone regimen as the first-line treatment for HR+/HER2－ metastatic breast cancer.
期刊：	2025年第36卷第15期
作者：	张冉冉；刘国强；张羽曦；高胜男；高宁；冯冰；刘冉；李倩
AUTHORS：	ZHANG Ranran，LIU Guoqiang，ZHANG Yuxi，GAO Shengnan，GAO Ning，FENG Bing，LIU Ran，LI Qian
关键字：	卡培他滨；节拍化疗；芳香化酶抑制剂；HR+/HER2－转移性乳腺癌；分区生存模型；成本-效用分析
KEYWORDS：	capecitabine； metronomic chemotherapy； aromatase inhibitors； HR+/HER2－ metastatic breast cancer； partitioned
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