| 引用本文: | 张亮,周秋云,侯文洁,方中坚,王洁.帕博利珠单抗一线治疗非小细胞肺癌的药物经济学分析[J].中国现代应用药学,2022,39(24):3284-3289. |
| ZHANG Liang,ZHOU Qiuyun,HOU Wenjie,FANG Zhongjian,WANG Jie.Pharmacoeconomic Analysis of Pembrolizumab as First-line Therapy for Advanced Non-Small Cell Lung Cancer[J].Chin J Mod Appl Pharm(中国现代应用药学),2022,39(24):3284-3289. |
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| 帕博利珠单抗一线治疗非小细胞肺癌的药物经济学分析 |
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张亮1,2,3, 周秋云1,2, 侯文洁1,2, 方中坚3, 王洁1,2
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1.南京市胸科医院药学部, 南京 210029;2.南京医科大学附属脑科医院, 南京 210029;3.中国药科大学国家药物政策与医药产业经济研究中心, 南京 211198
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| 摘要: |
| 目的 评估抗PD-1免疫治疗药物帕博利珠单抗与含铂双药化疗作为晚期非小细胞肺癌(nonsmall cell lung cancer,NSCLC)一线治疗的成本效用。方法 基于KEYNOTE-024研究比较一线帕博利珠单抗与铂双药治疗程序性死亡受体-配体1(programmed cell death-Ligand 1,PD-L1)组织多肽特异抗原(tissue polypeptide specific antigen,TPS) ≥ 50%、无表皮生长因子受体(epidermal growth factor receptor,EGFR)、间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)驱动基因突变的晚期NSCLC初治患者的生存、进展和安全性数据。使用已发表的成本数据计算增量成本效益比(incremental cost effectiveness ratio,ICER)。研究基于贝叶斯马尔可夫模型模拟终身的疾病转化,以美元估算成本并将有效性总结为质量调整生命年(quality-adjusted life-years,QALY)。结果 接受帕博利珠单抗治疗患者累积1.80 QALY(95% CrI 1.56~1.89),而含铂双药化疗为1.06 QALYs(0.94~1.13)。ICER为每个生命终了(end-of-life,EoL)调整后的QALY 52 000美元,超过了30 780美元的支付阈值门槛。结论 与含铂双药化疗相比帕博利珠单抗用于NSCLC一线治疗的成本效用有限,除非个体有更高的支付意愿。 |
| 关键词: 帕博利珠单抗 非小细胞肺癌 成本效用分析 |
| DOI：10.13748/j.cnki.issn1007-7693.2022.24.015 |
| 分类号:R969.3 |
| 基金项目:国家社会科学基金重大项目(15ZDB167)；南京市卫生科技发展项目(2021年管理B类课题12，2022年管理A类课题5)；江苏省药学会——奥赛康医院药学基金(A201909) |
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| Pharmacoeconomic Analysis of Pembrolizumab as First-line Therapy for Advanced Non-Small Cell Lung Cancer |
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ZHANG Liang1,2,3, ZHOU Qiuyun1,2, HOU Wenjie1,2, FANG Zhongjian3, WANG Jie1,2
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1.Department of Pharmacy, Nanjing Chest Hospital, Nanjing 210029, China;2.Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China;3.The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing 211198, China
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| Abstract: |
| OBJECTIVE To evaluate the anti-PD-1 immunotherapy drug-pembrolizumab compared to platinum-doublet chemotherapy as first-line therapy for advanced nonsmall cell lung cancer(NSCLC). METHODS Retrieved survival, progression, and safety data comparing first-line pembrolizumab to platinum-doublets for advanced NSCLC patients with PD-L1 expression ≥ 50%, non-mutated EGFR, and non-translocated ALK, from KEYNOTE-024. The analysis was based on a Bayesian Markov model of disease with full lifetime horizon. Estimated costs in USD and summarized effectiveness as quality-adjusted life-years(QALYs). RESULTS Patients treated with pembrolizumab accumulated 1.80 QALYs(95% CrI 1.56-1.89), compared to 1.06 QALYs(0.94-1.13) with chemotherapy. The ICER was $52 000 per end-of-life(EoL) adjusted QALY gained, above the $30 780 threshold. CONCLUSION Compared with platinum-doublets, pembrolizumab is not cost-effective in the first-line setting for patients with NSCLC, unless the individual has a higher willingness to pay. |
| Key words: pembrolizumab non-small cell lung cancer cost-utility |
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