Page 68 - 《中国药房》2022年12期

·药物经济学·

帕博利珠单抗联合化疗一线治疗晚期或转移性食管癌的成本-效

用分析 Δ

1＊
齐 冉 ，杜桂平 ，刘旭婷 ，高胜男 ，刘国强 （1.河北医科大学第三医院药剂科，石家庄 050051；2.河北省药
1 #
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物与卫生技术综合评估学会，石家庄 050051）
中图分类号 R956 文献标志码 A 文章编号 1001-0408（2022）12-1466-08
DOI 10.6039/j.issn.1001-0408.2022.12.10

摘 要 目的 评价帕博利珠单抗联合化疗对比单纯化疗一线治疗晚期或转移性食管癌的经济性。方法 从我国卫生体系角度出
发，利用三状态分区生存模型对帕博利珠单抗联合化疗对比单纯化疗一线治疗晚期或转移性食管癌进行成本-效用分析。模型模
拟时限为患者终生，3周为1个循环周期，生存数据利用KEYNOTE-590研究数据外推得到，成本数据来源于药智网2022年公开挂
网中标价格的中位值，其中帕博利珠单抗价格按慈善赠药方案折算后计，效用数据来源于文献，成本和效用均采用 5％的贴现
率。采用单因素敏感性分析和概率敏感性分析考察模型的稳健性。结果 基础分析结果显示，相较于单纯化疗方案，帕博利珠单
抗联合化疗方案在食管鳞状细胞癌（ESCC）、程序性蛋白死亡配体1综合阳性得分（PD-L1 CPS）≥10分和意向治疗（ITT）亚组患
者中的增量成本-效果比（ICER）分别为950 528.42、107 845.39、315 754.56元/质量调整生命年（QALY）。敏感性分析结果验证了
基础分析结果的稳健性。结论 在我国医疗卫生体系下，以1～3倍我国2021年人均国内生产总值为意愿支付阈值，相较于单纯化
疗方案，帕博利珠单抗联合化疗方案在ESCC和ITT亚组患者中不具有经济性，而在PD-L1 CPS≥10分亚组患者中具有经济性。
关键词 帕博利珠单抗；晚期食管癌；转移性食管癌；一线治疗；药物经济学；成本-效用分析

Cost-utility analysis of pembrolizumab combined with chemotherapy in the first-line treatment of advanced
or metastatic esophageal carcinoma
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1
QI Ran ，DU Guiping ，LIU Xuting ，GAO Shengnan ，LIU Guoqiang（1. Dept. of Pharmacy，the Third Hospital
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of Hebei Medical University，Shijiazhuang 050051，China；2. Hebei Society for Comprehensive Evaluation of
Drugs and Health Technology，Shijiazhuang 050051，China）
ABSTRACT OBJECTIVE To evaluate the cost-utility of pembrolizumab combined with chemotherapy versus chemotherapy
alone in the first-line treatment of advanced or metastatic esophageal carcinoma. METHODS Cost-utility analysis of pembrolizumab
combined with chemotherapy versus chemotherapy alone for advanced or metastatic esophageal carcinoma was conducted by using
a three-state partitioned survival model from the perspective of health system in China. The model used a lifetime simulation time
frame with 3 weeks as a cycle. The survival data were extrapolated using KEYNOTE-590 data；cost data were obtained from the
median of 2022 public winning bid on Yaozhi network，among which the price of pembrolizumab was obtained after discounting by
a patient assistance program；utility data were obtained from the literatures，and a 5％ discount rate was used for both cost and
utility. One-way sensitivity analysis and probabilistic sensitivity analysis were also conducted to examine model robustness.
RESULTS Analysis of the base case results showed that compared to chemotherapy alone，the incremental cost-effectiveness ratio
（ICER） of pembrolizumab combined with chemotherapy regimens were 950 528.42 yuan/QALY，107 845.39 yuan/QALY and
315 754.56 yuan/QALY for esophageal squamous cell carcinoma （ESCC），programmed deathligand-1 combined positive score
（PD-L1 CPS）≥10 and intention-to-treat population（ITT），respectively. The results of sensitivity analysis verified the robustness
of the basic analysis results. CONCLUSIONS Under our healthcare system，using a threshold of willingness-to-pay of 1-3 times
our GDP per capita in 2021，pembrolizumab combined with chemotherapy regimen isn’t cost-utility compared with chemotherapy
alone in the ESCC and ITT subgroups of patients，while it is cost-utility in the PD-L1 CPS≥10 subgroup of patients.
KEYWORDS pembrolizumab；advanced esophageal carcinoma；metastatic esophageal carcinoma；first-line treatment；pharmaco-
economics；cost-utility analysis

Δ 基金项目：河北省自然科学基金资助项目（No.H2021206407）
食管癌是全球第七大常见癌症，其病死率在所有癌
＊药师，硕士。研究方向：药物经济学。电话：0311-88603301。 [1]
症中排名第 6 位 。2019 年，全球有 53.0 万例新发食管
E-mail：qrd1122@163.com
癌病例和49.8万例食管癌死亡病例，其中以东亚国家的
# 通信作者：主任药师，硕士。研究方向：药物经济学、卫生技术
[2]
评估、合理用药。电话：0311-88603301。E-mail：liugq@sohu.com 发病率最高 。据统计，我国2017年新诊断和死亡的食
·1466 · China Pharmacy 2022 Vol. 33 No. 12 中国药房 2022年第33卷第12期