日本尼妥珠单抗加伊匹单抗联合疗法作为晚期肾细胞癌一线治疗的成本效益分析

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES

Value in health regional issues Pub Date : 2024-01-08 DOI:10.1016/j.vhri.2023.11.003

Tomomi Maeda BPharm , Kensuke Moriwaki PhD , Kosuke Morimoto MS , Xiuting Mo PhD , Takashi Yoshioka MD, PhD , Rei Goto MD, PhD , Kojiro Shimozuma MD, PhD

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引用次数: 0

摘要

本研究的目的是从日本医疗保险支付方的角度出发，研究日本晚期肾细胞癌患者接受尼妥珠单抗（NIVO）+伊匹单抗（IPI）联合疗法（NIVO + IPI）与舒尼替尼（SUN）疗法相比的成本效益。阈值设定为每个质量调整生命年（QALY）收益 75 000 美元。在分析方法上，我们采用了分区生存分析模型来估算增量成本效益比（ICER），即用增量成本除以增量 QALY。无进展生存期、疾病进展期和死亡被设定为健康状态。此外，成本参数和效用权重也被设定为关键参数。我们将中/低风险人群设定为基础病例。对意向治疗人群和有利风险人群进行了情景分析。结果在基础病例分析中，NIVO + IPI 和 SUN 的 QALY 分别为 4.32 和 2.99。NIVO+IPI可增加1.34个QALY。同时，NIVO + IPI 和 SUN 的总成本分别为 692 288 美元和 475 481 美元。因此，与 SUN 相比，NIVO + IPI 每获得 1 QALY 的 ICER 估计为 162 243 美元。对 ICER 影响较大的参数是 NIVO + IPI 中无进展生存期的效用权重。结论与 SUN 相比，NIVO + IPI 治疗晚期肾细胞癌在日本医疗系统中似乎不具成本效益。

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Cost-effectiveness Analysis of Nivolumab Plus Ipilimumab Combination Therapy as First-line Treatment for Advanced Renal Cell Carcinoma in Japan

Objectives

The purpose of this study is to examine the cost-effectiveness of nivolumab (NIVO) plus ipilimumab (IPI) combination therapy (NIVO + IPI) compared with the sunitinib (SUN) therapy for Japanese patients with advanced renal cell carcinoma from the perspective of a Japanese health insurance payer.

Methods

A lifetime horizon was applied, and 2% per annum was set as the discount rate. The threshold was set as $ 75 000 per quality-adjusted life-year (QALY) gained. For the analytical method, we used a partitioned survival analysis model to estimate the incremental cost-effectiveness ratio (ICER), which is calculated by dividing incremental costs by incremental QALYs. Progression-free survival, progressive disease, and death were set as health states. Additionally, cost parameters and utility weights were set as key parameters. We set the intermediate/poor-risk population as the base case. Scenario analysis was conducted for the intention-to-treat population and the favorable risk population. Furthermore, one-way sensitivity analysis and probabilistic sensitivity analysis were conducted for each population.

Results

In the base-case analysis, the QALYs of NIVO + IPI and SUN were 4.32 and 2.99, respectively. NIVO + IPI conferred 1.34 additional QALYs. Meanwhile, the total costs in the NIVO + IPI and SUN were $692 288 and $475 481, respectively. As a result, the ICER of NIVO + IPI compared with SUN was estimated to be $162 243 per QALY gained. The parameter that greatly affected the ICER was the utility weight of progression-free survival in NIVO + IPI.