| 引用本文: | 贾才凤,冯章英,张森,徐浩,康朔,李赛男,王明霞.阿贝西利联合氟维司群二线治疗激素受体阳性的晚期乳腺癌的药物经济学评价[J].中国现代应用药学,2023,40(12):1609-1614. |
| JIA Caifeng,FENG Zhangying,ZHANG Sen,XU Hao,KANG Shuo,LI Sainan,WANG Mingxia.Pharmacoeconomic Evaluation of Abemaciclib in Combination with Fulvestrant for Second-line Treatment of Hormone Receptor-positive Advanced Breast Cancer[J].Chin J Mod Appl Pharm(中国现代应用药学),2023,40(12):1609-1614. |
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| 阿贝西利联合氟维司群二线治疗激素受体阳性的晚期乳腺癌的药物经济学评价 |
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贾才凤1, 冯章英1, 张森2, 徐浩3, 康朔4, 李赛男5, 王明霞1
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1.河北医科大学第四医院, 临床药理研究部, 石家庄 050011;2.河北医科大学第四医院, 药学部, 石家庄 050011;3.河北医科大学第四医院, 医保办, 石家庄 050011;4.河北医科大学第二医院医保办, 石家庄 050011;5.河北医科大学第四医院, 乳腺中心, 石家庄 050011
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| 摘要: |
| 目的 从中国卫生体系角度评价阿贝西利联合氟维司群对比单用氟维司群二线治疗激素受体(hormone receptor，HR)阳性的晚期乳腺癌的经济性。方法 利用MONARCH 2临床试验公布的生存数据及相关成本和效用数据构建分区生存模型，模型循环周期设为4周，模拟时限为20年，贴现率设为5%。模型的产出指标为成本和质量调整生命年(quality-adjusted life year，QALY)，模型评价指标为增量成本-效果比(incremental cost-effectiveness ratio，ICER)。意愿支付阈值(willingness-to-pay threshold，WTP)为2021年中国1~3倍人均GDP(80 976元/QALY~242 928元/QALY)。进行不确定性分析以评价模型结果的稳健性。结果 基础分析结果显示，阿贝西利联合氟维司群同单用氟维司群相比可带来更多的健康获益，但同时总成本更高。增量效用及增量成本分别0.88 QALYs和306 014.57元，两方案相比的ICER值为348 507.45元/QALY。不确定性分析证实了模型结果具有稳健性。当阿贝西利价格降低70%时，阿贝西利联合氟维司群在中国3倍人均GDP下具有经济性的概率>50%。结论 阿贝西利联合氟维司群同单用氟维司群相比在二线治疗HR阳性的晚期乳腺癌患者时不具有成本-效果优势，但在北京、上海等较发达地区，阿贝西利联合氟维司群具有经济学优势。 |
| 关键词: 阿贝西利 氟维司群 晚期乳腺癌 HR阳性 药物经济学 |
| DOI：10.13748/j.cnki.issn1007-7693.20222787 |
| 分类号:R956 |
| 基金项目:“重大新药创制”国家科技重大专项(2020ZX09201006-003) |
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| Pharmacoeconomic Evaluation of Abemaciclib in Combination with Fulvestrant for Second-line Treatment of Hormone Receptor-positive Advanced Breast Cancer |
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JIA Caifeng1, FENG Zhangying1, ZHANG Sen2, XU Hao3, KANG Shuo4, LI Sainan5, WANG Mingxia1
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1.the Fourth Hospital of Hebei Medical University, Department of Clinical Pharmacology, Shijiazhuang 050011, China;2.the Fourth Hospital of Hebei Medical University, Department of Pharmacy, Shijiazhuang 050011, China;3.the Fourth Hospital of Hebei Medical University, Department of Medical Insurance, Shijiazhuang 050011, China;4.Department of Medical Insurance, the Second Hospital of Hebei Medical University, Shijiazhuang 050011, China;5.the Fourth Hospital of Hebei Medical University, Department of Breast Center, Shijiazhuang 050011, China
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| Abstract: |
| OBJECTIVE To evaluate the economics of abemaciclib combined with fulvestrant compared with single use of fulvestrant in the second-line treatment of hormone receptor(HR)-positive advanced breast cancer from the perspective of Chinese health-care system. METHODS A partitioned survival model was conducted by using the survival data published from the MONARCH 2 clinical trial and associated cost and utility data. The cycle length of the model was 4 weeks and the time horizon of the model was set to 20 years, the discount rate was 5%. The output indicators of the model were cost and quality-adjusted life year (QALY), and the evaluation indicator of the model was incremental cost-effectiveness ratio(ICER). The willingness-to-pay threshold(WTP) was 1-3 times per capita GDP(￥80 976/QALY-￥242 928/QALY) in China in 2021. Uncertainty analyses were performed to evaluate the robustness of the model results. RESULTS The results of the base-case analyses showed that abemaciclib combined with fulvestrant could bring more health benefits than single use of fulvestrant, but at the same time, the total cost was higher. The incremental QALYs and incremental costs were 0.88 QALYs and ￥306 014.57, respectively, resulting the ICER were ￥348 507.45/QALY. The uncertainty analyses confirmed the robustness of the model results. When the price of abemaciclib reduced 70%, the probability of abemaciclib combined with fulvestrant being cost-effective was more than 50% under the 3 times per capita GDP in China. CONCLUSION Abemaciclib combined with fulvestrant do not have a cost-effective advantage over single use of fulvestrant in second-line treatment of HR-positive advanced breast cancer. However, in more developed regions such as Beijing, Shanghai, abemaciclib combined with fulvestrant has economic advantages. |
| Key words: abemaciclib fulvestrant advanced breast cancer HR-positive pharmacoeconomics |
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