贝伐珠单抗联用厄洛替尼对比贝伐珠单抗单用在晚期非小细胞肺癌维持治疗中的成本-效用

摘要

Bevacizumab plus erlotinib prolonged patients' progression-free survive (PFS) versus bevacizumab alone for the maintenance treatment of none-small cell lung cancer (NSCLC) in phase Ⅲ clinical trial ATLAS (ClinicalTrials.gov identifier NCT00257608),which repealed a benefit outcome and acceptable side-effects,but whether its cost performance would be accepted by patients is blurry.The aim of our research is to figure out which strategy is the best option in clinic and would spread broadly.Markov Model was used to calculate incremental cost-utility radios (ICURs) and 10-year quality-adjusted life years (QALY) of both strategies.The clinical data were collected from phase Ⅲ clinical trial ATLAS (ClinicalTrials.gov identifier NCT00257608).The cost data were obtained from Chinese health care system.In the research,one-way sensitivity analysis,probabilistic sensitivity analysis (PSA) and Monte-Carlo analysis were performed to test the stability of the results.The better strategy was bevacizumab alone strategy,and the cumulative costs of both strategies were $178 648.47 and $46 445.28,respectively,and the QALY was 12.506 and 10.643,respectively.The ICUR of combined application was $70 962.53/QALY,which was much higher than 3 times of mean gross domestic product (GDP) in China,suggesting that this strategy was no economical at all.In one-way analysis,the change of willingness-to-pay could not influence the consequence.In addition,in Monte-Carlo analysis,the probability distribution of cost,effectiveness and ICUR was in normal distribution.Taken together,bevacizumab alone strategy was the better strategy in terms of cost-effectiveness.%尽管一项多中心临床Ⅲ期试验表明在晚期非小细胞肺癌维持治疗中厄洛替尼联用贝伐珠单抗对比贝伐珠单抗单用可增加无进展生存期,但联用方案长期使用的经济性未知,而本研究目的是评价上述两种治疗方案何者最佳.本研究以临床三期试验ATLAS为对象,通过马尔科夫模型模拟10年,以增量成本-效用为产出,估算两种治疗方案的合理性.结果表明,联用方案为最佳方案,增量成本-效用为$70962.53/QALY,该值明显高于我国3倍人均GDP,说明联用方案不具有成本-效用性.一元敏感度分析表明,改变各因素对结果无影响,而概率敏感度分析表明,成本及效用概率敏感度分布呈正太分布,说明结果的稳定性.结果显示,贝伐珠单抗单用方案为最佳治疗方案.