摘要
目的:从全社会角度评估阿来替尼相比于克唑替尼,一线治疗中国ALK阳性晚期或转移性非小细胞肺癌的长期成本效果。方法:采用三种健康状态(无进展、进展、死亡)构建分区生存模型。临床数据、健康效用值来源于头对头的ALEX等相关临床试验、文献等。费用数据包括直接医疗费用和间接费用。结果:在30年研究时限下,阿来替尼组患者获得的质量调整生命年(QALY)为2.96 QALY,克唑替尼组为2.08 QALY,阿来替尼相比于克唑替尼的增量成本效果比为169,848元/QALY。阿来替尼组患者脑转移相关费用和进展状态相关费用显著低于克唑替尼组。结论:阿来替尼相比于克唑替尼,可大幅延长生命年并带来显著的QALY获益,有效节约脑转移和进展状态相关费用,同时其无进展状态的治疗时间延长也使得总体成本有所上涨。参考中国2018年人均GDP的3倍(193,932元)标准,阿来替尼可以被认为具有成本效果优势。
Objectives:To evaluate the long-term economic benefits of Alectinib versus Crizotinib in firstline treatment for ALK+advanced non-small cell lung cancer(NSCLC)from a China societal perspective.Methods:A cost-utility model was developed using partition survival methods and three health states.Survival data and utility values were derived from ALEX trial.Cost inputs were estimated from literature,publicly available price references,and key opinion leader interview.Results:In a base case of 30-year lifetime horizon,Alectinib was associated with 2.96 quality-adjusted life years(QALYs),while Crizotinib was associated with 2.08 QALYs.Alectinib had better health outcome and marginal cost increase,yielding an Incremental cost-effectiveness ratio of 169,848 CNY/QALY.Cost during post progression survival and central nervous system-related costs were considerably lower with Alectinib.Conclusion:In comparison with Crizotinib,Alectinib significantly improved progression free survival and provided considerable incremental QALYs with its marginal cost increase being reflective of longer treatment duration in the PFS state.From a China societal perspective,Alectinib may be considered as a cost-effective therapy for the first-line treatment of ALK+NSCLC patients.
作者
张力
周彩存
赵军
胡洁
董晓蓉
明坚
Zhang Li;Zhou Caicun;Zhao Jun;Hu Jie;Dong Xiaorong;Ming Jian(Sun Yat-sen University Cancer Center,Guangzhou,510060;Shanghai Pulmonary Hospital,Shanghai,200433;Beijing Cancer Hospital,Beijing,100142;Zhongshan Hospital,Fudan University,Shanghai,200032;Un ion Medical College Hospital,Huazhong University of Science and Technology,Wuhan,430022;IQVIA Solutions Enterprise Management Consulting(Shanghai)Co.Ltd,Shanghai,200041)
出处
《中国医疗保险》
2019年第12期56-62,共7页
China Health Insurance
关键词
阿来替尼
ALK阳性
非小细胞肺癌
成本效果
Alectinib
ALK positive
non-small cell lung cancer
cost-effectiveness
