Page 83 - 《中国药房》2021年22期

·药物经济学·

基于两种模型的帕博利珠单抗二线治疗晚期肝细胞癌的成本-效

用分析 Δ

孟 蕊 1，2＊ ，周 挺 ，石丰豪 ，王子婧 ，罗孟捷 ，马爱霞 （1.中国药科大学国际医药商学院，南京
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211198；2.中国药科大学药物经济学评价研究中心，南京 211198）
中图分类号 R956 文献标志码 A 文章编号 1001-0408（2021）22-2761-06
DOI 10.6039/j.issn.1001-0408.2021.22.13

摘 要 目的：评价帕博利珠单抗二线治疗我国晚期肝细胞癌患者的经济性。方法：从我国卫生体系角度出发，同时建立三状态
分区生存模型及Markov模型，评价帕博利珠单抗对比安慰剂二线治疗我国晚期肝细胞癌患者的成本及效用，模型循环周期为3
周，研究时限为终生；采用单因素敏感性分析、概率敏感性分析以及情境分析验证基础分析结果的稳健性。结果：分区生存模型分
析结果表明，使用帕博利珠单抗二线治疗我国晚期肝细胞癌患者的增量成本-效果比（ICER）为 1 266 846.18 元/QALY，远超 3 倍
2020年我国人均国内生产总值（GDP）。单因素敏感性分析结果表明，对ICER影响最大的3个参数分别为安慰剂组无进展生存期
（PFS）状态效用值、帕博利珠单抗组PFS状态效用值以及帕博利珠单抗成本。概率敏感性分析结果验证了基础分析的稳健性。情
境分析结果表明，在考虑帕博利珠单抗慈善赠药的情况下，其治疗成本大幅下降，虽仍不具经济性，但其ICER接近于3倍2020年
我国人均 GDP。当意愿支付阈值分别为 1、3 倍我国人均 GDP 时，帕博利珠单抗（100 mg）具有经济性的价格分别为 4 157.67、
5 829.24元。Markov模型分析结果与分区生存模型相似。结论：在1～3倍2020年我国人均GDP的意愿支付阈值下，帕博利珠单
抗方案用于我国晚期肝细胞癌患者的二线治疗不具经济性。
关键词 帕博利珠单抗；晚期肝细胞癌；二线治疗；分区生存模型；Markov模型；成本-效用分析；情境分析
Cost-utility Analysis of Pembrolizumab in the Second-line Treatment of Advanced Hepatocellular
Carcinoma Based on Two Models
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MENG Rui ，ZHOU Ting ，SHI Fenghao ，WANG Zijing ，LUO Mengjie ，MA Aixia （1. School of
International Pharmaceutical Business，China Pharmaceutical University，Nanjing 211198，China；2. Pharmaco-
economic Evaluation Research Center，China Pharmaceutical University，Nanjing 211198，China）
ABSTRACT OBJECTIVE：To evaluate the economics of pembrolizumab in the second-line treatment of advanced hepatocellular
carcinoma in China. METHODS：From the perspective of Chinese healthcare system，a three-state PartSA model and Markov
model were established；the cost and utility for the second-line treatment of advanced hepatocellular carcinoma in China were
compared between pembrolizumab and placebo. The circulation cycle of the model was 3 weeks and the study time limit was
lifetime；one-way sensitivity analysis，probability sensitivity analysis and scenario analysis were used to verify the robustness of the
base-case analysis results. RESULTS：PartSA results showed that the ICER for the second-line treatment of advanced hepato-
cellular carcinoma with pembrolizumab was 1 266 846.18 yuan/QALY，which is far more than 1-3 times of China’s per capita
GDP in 2020. The results of one-way sensitivity analysis showed that the three parameters that had the greatest impact on ICER
were the PFS status utility of the placebo group， the PFS status utility of the pembrolizumab group， and the cost of
pembrolizumab. The results of probability sensitivity analysis verified the robustness of the base-case analysis. The scenario analysis
showed that the treatment cost of pembrolizumab had dropped significantly when the charity donation of pembrolizumab was
considered. Although it was still not economical，ICER was close to 3 times of per capita GDP of China in 2020. When WTP
threshold was 1 and 3 times of China’s per capita GDP，the economic prices of pabolizumab（100 mg）were 4 157.67 and 5 829.24
yuan，respectively. The results of Markov model were similar to those of PartSA model. CONCLUSIONS：Under the WTP
threshold of 1-3 times China’s per capita GDP in 2020，
Δ 基金项目：2020 江苏省高校哲学社会科学研究一般项目
pembrolizumab is not economical for second-line treatment of
（No.2020SJA0089）
advanced hepatocellular carcinoma.
＊硕士研究生。研究方向：药物经济学、卫生经济与政策。
E-mail：981095209@qq.com KEYWORDS Pembrolizumab；Advanced hepatocellular car-
# 通信作者：教授，博士生导师，博士。研究方向：药物经济学、卫 cinoma； Second-line treatment； PartSA model； Markov
生经济与政策。E-mail：ma86128@sina.com model；Cost-utility analysis；Scenario analysis

中国药房 2021年第32卷第22期 China Pharmacy 2021 Vol. 32 No. 22 ·2761 ·