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阿帕替尼联合多柔比星二线治疗铂类耐药的复发性卵巢癌的成

本-效果分析

＊
詹少卿 ，柳小亚，周佳琦，陈 霞（南通市第一人民医院药剂科，江苏 南通 226000）

中图分类号 R956 文献标志码 A 文章编号 1001-0408（2024）10-1238-05
DOI 10.6039/j.issn.1001-0408.2024.10.15

摘 要 目的 从中国卫生体系角度评价阿帕替尼联合多柔比星二线治疗铂类药物耐药的复发性卵巢癌（OC）的经济性。方法
基于APPROVE试验和相关文献数据构建三状态分区生存模型，模型模拟时限为10年，循环周期为4周，成本和效果的贴现率为
5%。以成本和质量调整生命年（QALYs）作为模型产出指标并计算增量成本-效果比（ICER），评价阿帕替尼联合多柔比星对比多
柔比星单独化疗二线治疗铂类药物耐药的复发性OC的经济性，并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 基础分析结果表明，与单独化疗相比，阿帕替尼联合多柔比星方案的ICER为124 678.25元/QALY，
低于本研究设定的意愿支付（WTP）阈值（3倍我国2022年人均国内生产总值257 094元）。情境分析结果显示，随着模拟时限的延
长，阿帕替尼联合多柔比星方案的ICER逐渐降低，降幅逐渐减小，均低于本研究设定的WTP阈值。单因素敏感性分析结果显示，
对ICER影响程度最大的因素包括疾病进展状态效用值、体表面积、贴现率和最佳支持治疗成本等。概率敏感性分析结果表明，在
本研究设定的 WTP 阈值下，阿帕替尼联合多柔比星方案具有经济性的概率超过 99%。结论 从中国卫生体系角度，以 3 倍我国
2022年人均国内生产总值为WTP阈值，阿帕替尼联合多柔比星对比多柔比星单独化疗二线治疗铂类药物耐药的复发性OC更具
经济性。
关键词 阿帕替尼；多柔比星；铂类耐药；复发性卵巢癌；分区生存模型；成本-效果分析

Cost-effectiveness analysis of apatinib combined with adriamycin for second-line treatment of platinum-
resistant recurrent ovarian cancer
ZHAN Shaoqing，LIU Xiaoya，ZHOU Jiaqi，CHEN Xia（Dept. of Pharmacy， Nantong First People’s Hospital，

Jiangsu Nantong 226000， China）

ABSTRACT OBJECTIVE To evaluate the cost-effectiveness of apatinib combined with adriamycin in the second-line
chemotherapy of platinum-resistant recurrent ovarian cancer （OC） from the perspective of the health system in China. METHODS
A three-state partitioned survival model was constructed based on the APPROVE clinical trial and related literature data， with a
model simulation time frame of 10 years and a 4-week cycle， and both cost and utility values were discounted using a 5% discount
rate. Cost and quality-adjusted life years （QALYs） were used as a model output indicator and the incremental cost-effectiveness ratio
（ICER） was calculated to evaluate the cost-effectiveness of apatinib combined with adriamycin versus adriamycin chemotherapy in
the second-line treatment of platinum-resistant recurrent OC. One-way sensitivity analysis， probability sensitivity analysis and
scenario analysis were used to verify the robustness of the base-case analysis results. RESULTS The results of base-case analysis
indicated that compared with chemotherapy alone， ICER of patients receiving apatinib combined with adriamycin was 124 678.25
yuan/QALY， which was less than willingness-to-pay （WTP） threshold set in this study [3 times per capita gross domestic product
（GDP） of China in 2022 （257 094 yuan）]. The results of scenario analysis showed that， with the extension of the simulation time
limit， the ICER of apatinib combined with adriamycin was gradually reduced， and the decline was gradually reduced， but both
were less than WTP threshold. The results of single factor sensitivity analysis showed that the factors that had the greatest impact on
ICER were the utility value of progression， body surface area， discount rate，and the cost of best supportive treatment， etc. The
results of probability sensitivity analysis showed that under WTP threshold set in this study， the economic probability of apatinib
combined with adriamycin was about 99%. CONCLUSIONS From the perspective of China’s health system， using three times the
per capita GDP in 2022 as the WTP threshold， the combination of apatinib and adriamycin is more cost-effective than adriamycin
alone in second-line chemotherapy for platinum-resistant recurrent OC.
KEYWORDS apatinib； adriamycin； platinum-resistant； recurrent ovarian cancer； partitioned survival model； cost-effectiveness
analysis
＊第一作者 副主任药师。研究方向：药物经济学、临床药学。
E-mail：863538216@qq.com

· 1238 · China Pharmacy 2024 Vol. 35 No. 10 中国药房 2024年第35卷第10期