奥拉帕利治疗HER2阴性转移性乳腺癌的成本-效用分析-现代医学

奥拉帕利治疗HER2阴性转移性乳腺癌的成本-效用分析

单位：1. 长治市人民医院药学部, 山西长治 046000;
2. 长治市人民医院乳腺外科, 山西长治 046000

分类号：R737.9

出版年·卷·期（页码）：2023·51·第五期（604-610）

摘要：

目的：评价奥拉帕利相比化疗药在人表皮生长因子受体-2(HER2)阴性转移性乳腺癌治疗中的经济性。方法：根据HER2阴性转移性乳腺癌的疾病进展和转归，基于国外一项已发表的Ⅲ期临床研究，选择Markov模型对奥拉帕利和化疗药两种治疗方案进行经济学的评价，模型中包括无进展状态、进展状态和死亡。采用单因素敏感性分析和概率敏感性分析评价模型参数变化对结果稳定性的影响。结果：奥拉帕利组较之化疗药组的增量成本-效果比(ICER)值为2 377 827.78元·(质量调整生命年)^-1。奥拉帕利单价、化疗药组接受艾立布林治疗的患者比例是对该模型影响较大的参数。结论：相比化疗药，奥拉帕利的ICER远超意愿支付阈值，不具有成本-效用优势。

Objective: To compare the economic effectiveness of olaparib with chemotherapy in the treatment of human epidermal growth factor receptor 2(HER2) negative metastatic breast cancer. Methods: Based on a published phaseⅢ randomized clinical controlled trial and according to the disease progression of patients with metastatic breast cancer, the Markov model was established and used to evaluate the economic effectiveness of the two treatments. The model included three health states,i.e., non-progressive free survival state, disease progress state and death state. One-way sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the influence of model parameter changes on the robustness of the results. Results: The incremental cost effectiveness ratio(ICER) value in olaparib group versus chemotherapy group was 2377827.78 yuan/quality-adjusted life year(QALY). The sensitivity analysis showed that the olaparib unit price and the proportion of patients in chemotherapy group treated with Eribulin were the most influential parameters in the model. Conclusion: The incremental cost-effectiveness ratio of the olaparib far exceeds the established willingness to pay(WTP) compared with the chemotherapy group, and the olaparib has no cost-effectiveness advantage.

参考文献：

[1] 中国抗癌协会乳腺癌专业委员会.中国乳腺癌筛查与早期诊断指南[J].中国癌症杂志,2022,32(4):363-372.
[2] 中华人民共和国国家卫生健康委员会.乳腺癌诊疗指南(2022年版)[EB/OL].[2022-04-11].http://www.nhc.gov.cn/yzygj/s2911/202204/a0e67177df1f439898683e1333957c74.shtml.
[3] TUTT A N J,GARBER J E,KAUFMAN B,et al.Adjuvant olaparib for patients with BRCA1-or BRCA2-mutated breast cancer[J].N Engl J Med，2021，384:2394-2405.
[4] 中国临床肿瘤学会指南工作委员会.中国临床肿瘤学会(CSCO)乳腺癌诊疗指南2021[M].北京：人民卫生出版社,2021:84-85.
[5] ROBSON M,TUNG N,CONTE P,et al.OlympiAD final overall survival and tolerability results:olaparib versus chemotherapy treatment of physician's choice in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer[J].Ann Oncol,2019,30(4):558-566.
[6] ROBSON M,IM S A,SENKUS E,et al.Olaparib for metastatic breast cancer in patients with a germline BRCA mutation[J].N Engl J Med,2017,377(6):523-533.
[7] PARACHA N,THURESSON P O,MORENO S G,et al.Health state utility values in locally advanced and metastatic breast cancer by treatment line:a systematic review[J].Expert Rev Pharmacoecon Outcomes Res,2016,165:549-559.
[8] LIU X Y,LANG Y T,LIAO Y H,et al.Atezolizumab plus chemotherapy vs.chemotherapy in advanced or metastatic triple-negative breast cancer:a cost-effectiveness analysis[J].Front Public Health,2021,9:756899.
[9] MARTIKAINEN J A,KIVIOJA A,HALLINEN T,et al.Economic evaluation of temozolomide in the treatment of recurrent glioblastoma multiforme[J].Pharmacoeconomics,2005,23(8):803-815.
[10] MILLER D K,HOMAN S M.Determining transition probabilities:confusion and suggestions[J].Med Decis Making,1994,14(1):52-58.
[11] 国家卫生健康委员会.中国居民营养与慢性病状况报告(2020年)[J].营养学报,2020,42(6):521.
[12] 刘国恩.中国药物经济学评价指南[M].北京：中国市场出版社有限公司,2020:34-46.
[13] 国家统计局.中华人民共和国 2021 年国民经济和社会发展统计公报[N].人民日报，2022-3-1(10).
[14] BRIGGS A H,WEINSTEIN M C,FENWICK E A,et al.Model parameter estimation and uncertainty analysis:a report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group-6[J].Med Decis Making,2012,32(5):722-732.
[15] 朱娟,王乐,何世娇，等.中国乳腺癌健康效用值研究的系统评价[J].中国循证医学杂志,2017,17(9):1066-1071.

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