Evaluating the cost-effectiveness of atezolizumab-bevacizumab in advanced hepatocellular carcinoma: Insights from Taiwan.

IF 2.6 3区 农林科学 Q2 FOOD SCIENCE & TECHNOLOGY
Tsung-Wei Chang, Wei-Chiao Chang, Wan-Hsuan Chou, Wei-Pin Chang, Chun-Nan Kuo
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Abstract

Following the observed significant improvements in overall survival and progression-free survival in clinical trials, the combination of atezolizumab and bevacizumab has been recommended as a first-line therapy for patients with unresectable hepatocellular carcinoma. Despite its clinical benefits, the high cost associated with this treatment poses a substantial challenge in routine practice in Taiwan. This study aims to assess the cost-effectiveness of atezolizumab plus bevacizumab in comparison to sorafenib monotherapy. This study utilized partitioned survival analysis and extrapolated survival over a 20-year horizon to conduct a cost-effectiveness analysis from the perspective of the National Health Insurance Administration. Efficacy and utility data were directly extracted from the IMbrave150 trial, with input parameters adjusted to align with clinical practice in Taiwan. One-way deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the results. Additionally, a scenario analysis was conducted to evaluate the impact of bevacizumab use on the outcomes. Compared to sorafenib, the combination of atezolizumab and bevacizumab resulted in an increase of 0.53 quality-adjusted life years (QALYs) and had an incremental cost of NT$1,867,151. The incremental cost-effectiveness ratio (ICER) was NT$3,523,768 per QALY, exceeding the commonly accepted willingness-to-pay threshold at NT$2,788,290 (three times Taiwan's gross domestic product per capita). One-way sensitivity analysis indicated that reducing the cost of atezolizumab plus bevacizumab to 70% would yield an ICER of NT$1,793,703. Scenario analysis demonstrated cost reduction in bevacizumab, either through the adoption of a biosimilar product or lower dosage, would make the combination cost-effective. Under Taiwan's National Health Insurance (NHI) system and based on the cost-effectiveness analysis in 2021, the combination of atezolizumab and bevacizumab is not cost-effective compared to sorafenib monotherapy for the treatment of unresectable hepatocellular carcinoma.

评估atezolizumab-bevacizumab治疗晚期肝细胞癌的成本效益:来自台湾的见解。
在临床试验中观察到总生存期和无进展生存期的显著改善后,atezolizumab和贝伐单抗联合被推荐为不可切除肝细胞癌患者的一线治疗。尽管它的临床效益,与此治疗相关的高成本在台湾的常规实践中提出了实质性的挑战。本研究旨在评估与索拉非尼单药治疗相比,atezolizumab加贝伐单抗的成本效益。本研究从国家健康保险局的角度出发,采用分区生存分析和20年外推生存分析进行成本-效果分析。疗效和效用数据直接从IMbrave150试验中提取,并调整输入参数以符合台湾的临床实践。进行了单向确定性和概率敏感性分析来评估结果的稳健性。此外,还进行了情景分析,以评估贝伐单抗使用对结果的影响。与索拉非尼相比,阿特唑单抗与贝伐单抗联合使用可增加0.53质量调整生命年(QALYs),增加成本为新台币1,867,151元。每个QALY的增量成本效益比(ICER)为新台币3,523,768元,超过普遍接受的支付意愿门槛新台币2,788,290元(台湾人均国内生产总值的三倍)。单因素敏感性分析显示,将阿特唑单抗加贝伐单抗的成本降低至70%,ICER为新台币1,793,703元。情景分析表明,通过采用生物类似药或降低剂量来降低贝伐单抗的成本,将使联合用药具有成本效益。根据台湾的国民健康保险(NHI)制度,基于2021年的成本效益分析,与索拉非尼单药治疗相比,atezolizumab和bevacizumab联合治疗不可切除的肝细胞癌的成本效益不高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Food and Drug Analysis
Journal of Food and Drug Analysis 医学-食品科技
CiteScore
6.30
自引率
2.80%
发文量
36
审稿时长
3.8 months
期刊介绍: The journal aims to provide an international platform for scientists, researchers and academicians to promote, share and discuss new findings, current issues, and developments in the different areas of food and drug analysis. The scope of the Journal includes analytical methodologies and biological activities in relation to food, drugs, cosmetics and traditional Chinese medicine, as well as related disciplines of topical interest to public health professionals.
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