表达PD-L1≥50%的II-IIIA期非小细胞肺癌辅助治疗阿替利珠单抗的成本效益分析：英国的医疗观点

SCI

20 March 2023

Cost-effectiveness analysis of adjuvant atezolizumab in stage II-IIIA non- small cell lung cancer expressing ≥ 50% PD-L1: A United Kingdom health care perspective

（Lung Cancer；IF: 6.081）

Chui-ying Yip, Alastair Greystoke, Seye Abogunrin, Rossella Belleli, Danilo Di Maio, Peter Rouse, Nick Jovanoski  

CORRESPONDENCE TO: chui-ying.yip@roche.com 

Objective 目的  

Atezolizumab monotherapy has marketing authorisation by the Medicines and Healthcare products Regulatory Agency as adjuvant treatment following complete resection for adults with stage II–IIIA non-small cell lung cancer (NSCLC) whose tumours have PD-L1 expression on ≥ 50% of tumour cells and whose disease has not progressed following adjuvant platinum-based chemotherapy. This study evaluated the cost-effectiveness of atezolizumab vs best supportive care (BSC) in the licensed patient population from a UK perspective. 

阿替利珠单抗(atezolizumab)单药已获得药品和保健品管理局的上市授权，适用于II-IIIA期非小细胞肺癌（NSCLC）完全切除后，肿瘤的PD-L1表达量≥50%，辅助铂类化疗后疾病没有进展的成人患者的辅助治疗，其。本研究从英国的角度评估了Atezolizumab与最佳支持性治疗（BSC）在患者群体中的成本效益。

Materials and Methods 材料与方法  

Patient characteristics and clinical inputs were derived from the global, randomised, open-label, phase III IMpower010 trial. A Markov model with the following health states was developed: disease-free survival (DFS), locoregional recurrence, first-line metastatic recurrence, second-line metastatic recurrence, and death (all partitioned based on receipt of treatment, excluding death). The base case model used a lifetime time horizon (40 years) and 3.5% discounting annually after the first year. DFS from IMpower010 was analysed with parametric survival models to extrapolate outcomes for time points beyond trial follow-up. The models were adjusted to avoid overestimating results for patients with recurrences in the longer term. Grade ≥ 3 treatment-related adverse events with incidences ≥ 2% were included. Health state utility values were derived from the literature and past NICE appraisals. Sensitivity and scenario analyses assessed uncertainty around assumptions and parameter estimates. 

患者特征和临床信息来自全球随机、开放标签、III期IMpower010试验。建立了一个具有以下健康状态的马尔可夫模型：无病生存（DFS）、局部复发、一线转移性复发、二线转移性复发和死亡（都是根据接受治疗情况划分的，不包括死亡）。基本案例模型采用终身时间跨度（40年）和第一年后每年降低3.5%。用参数生存模型分析IMpower010的DFS，以推断试验随访后的时间点的结果。对模型进行了调整，以避免高估长期复发患者的结果。发病率≥2%的≥3级治疗相关不良事件被包括在内。健康状态效用值来自文献和过去的NICE评估。敏感性和情景分析评估了假设和参数估计的不确定性。

Results 结果  

In the base case analysis, atezolizumab therapy resulted in an expected gain of 1.87 quality-adjusted life-years (QALYs) corresponding to an incremental cost-effectiveness ratio of £20,392/QALY for atezolizumab vs BSC, demonstrating cost-effectiveness. Results were most influenced by discount effects and utility in the on-treatment DFS state. Scenario analyses were consistent with the base case results. 

在基础案例分析中，atezolizumab治疗带来了1.87个质量调整寿命年（QALYs）的预期收益，相当于atezolizumab与BSC的增量成本效益比为20,392英镑/QALY，显示了成本效益。结果受折扣效应和治疗中DFS状态的效用影响最大。情景分析与基本情况结果一致。

Conclusions 结论  

Atezolizumab after adjuvant chemotherapy is cost-effective for adults with NSCLC in the UK. 

在英国，辅助化疗后使用atezolizumab对成人NSCLC患者来说是具有成本效益的。

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