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NALIRIFOX方案一线治疗转移性胰腺癌的经济学评价
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| 篇名： | NALIRIFOX方案一线治疗转移性胰腺癌的经济学评价 |
| TITLE： | Economic evaluation of NALIRIFOX regimen for first-line treatment of metastatic pancreatic cancer |
| 摘要： | 目的 从我国卫生体系角度出发，评价伊立替康脂质体+氟尿嘧啶+亚叶酸钙+奥沙利铂（NALIRIFOX方案）相比紫杉醇（白蛋白结合型）联合吉西他滨（AG方案）一线治疗转移性胰腺癌的经济性。方法基于NAPOLI3临床试验数据构建动态Markov模型，循环周期为28d，模拟时限为5年。以增量成本-效果比（ICER）和质量调整生命年（QALY）作为模型产出指标，以3倍我国2024年人均国内生产总值（GDP）作为意愿支付（WTP）阈值，以5%为贴现率，采用成本-效用分析法分析NALIRIFOX方案相对于AG方案的经济性。采用单因素敏感性分析和概率敏感性分析来评价模型结果的稳健性，并以伊立替康脂质体分别降价60%、70%进行情境分析。结果基础分析结果显示，NALIRIFOX方案相对于AG方案的ICER为854669.96元/QALY，大于WTP阈值（287247元/QALY），说明NALIRIFOX方案不具有经济性。单因素敏感性分析结果表明，贴现率、伊立替康脂质体成本、无进展生存状态效用值和疾病进展状态效用值对ICER的影响较大。概率敏感性分析结果表明，在本研究的WTP阈值下，NALIRIFOX方案相对于AG方案不具有经济性。情境分析结果显示，当降价70%时，NALIRIFOX方案相对于AG方案具有经济性的概率为9.60%。结论从我国卫生体系角度出发，在以3倍我国2024年人均GDP作为WTP阈值时，NALIRIFOX方案相对于AG方案一线治疗转移性胰腺癌不具有经济性。 |
| ABSTRACT： | OBJECTIVE From the perspective of China’s health system， to evaluate the economic efficiency of Irinotecan liposome+fluorouracil+calcium folinate+oxaliplatin（NALIRIFOX regimen） versus paclitaxel （albumin-bound） combined with gemcitabine （AG regimen） in the first-line treatment of metastatic pancreatic cancer. METHODS A dynamic Markov model was constructed based on the data from the NAPOLI 3 clinical trial， with a cycle period of 28 days and a simulation time limit of 5 years. Incremental cost-effectiveness ratio （ICER） and quality-adjusted life year （QALY） were used as the model output indicators. The willingness-to-pay （WTP） threshold was set at three times China’s 2024 per capita gross domestic product （GDP）， and a discount rate of 5% was adopted. A cost-utility analysis was conducted to analyze the economic efficiency of the NALIRIFOX regimen compared to the AG regimen. Univariate sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the robustness of the model results， and scenario analysis was conducted by reducing the cost of irinotecan liposome by 60% and 70%. RESULTS The base-case analysis showed that the ICER of the NALIRIFOX regimen was 854 669.96 yuan/QALY compared to the AG regimen， which was greater than the WTP threshold （287 247 yuan/QALY）， indicating that the NALIRIFOX regimen was not economically efficient. The univariate sensitivity analysis results indicated that the discount rate， the cost of irinotecan liposome， the utility value of the progression-free survival state， and the utility value of the disease progression state had a significant impact on the ICER. The probabilistic sensitivity analysis results showed that under the WTP threshold of this study， the NALIRIFOX regimen was not economically efficient compared with the AG regimen. The scenario analysis results indicated that when the price was reduced by 70%， the probability of the NALIRIFOX regimen being economically efficient compared with the AG regimen was 9.60%. CONCLUSIONS From the perspective of China’s health system， when the WTP threshold is set at three times China’s 2024 per capita GDP， the NALIRIFOX regimen is not economically efficient in the first-line treatment of metastatic pancreatic cancer， compared with the AG regimen. |
| 期刊： | 2025年第36卷第21期 |
| 作者： | 高晗；胡冬雪；贾才凤；王明霞 |
| AUTHORS： | GAO Han，HU Dongxue，JIA Caifeng，WANG Mingxia |
| 关键字： | 伊立替康脂质体；NALIRIFOX方案；转移性胰腺癌；一线治疗；Markov模型；药物经济学；成本-效用分析 |
| KEYWORDS： | Irinotecan liposome； NALIRIFOX regimen； |
| 阅读数： | 1 次 |
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