伊朗 HER2 阳性胃癌治疗中曲妥珠单抗加化疗与单纯化疗的成本效益分析。

IF 2.7 3区 经济学 Q1 ECONOMICS
Sara Kaveh, Nashmil Ghadimi, Amirhossein Zarei Alvar, Kamran Roudini, Rajabali Daroudi
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引用次数: 0

摘要

背景:曲妥珠单抗与化疗联合治疗 HER2 阳性胃癌显示出治疗前景,但可能会增加成本。我们旨在评估伊朗 HER2 阳性胃癌治疗中曲妥珠单抗与化疗联合应用的成本效益:我们采用了分区生存模型(PSM)来评估曲妥珠单抗联合化疗与单独化疗的成本效益。分区生存模型框架包括三种不同的健康状态:无进展、进展后和死亡。临床数据(包括总生存率和无进展生存率)来自随机对照研究 ToGA 试验。在计算成本时采用了自下而上的方法,分别考虑了无进展状态和进展后状态的药物成本、不良事件管理成本和其他疾病管理成本。分析从伊朗医疗保健系统的角度出发,考虑了直接医疗成本。我们进行了成本效益分析,通过比较增量成本效益比 (ICER) 和伊朗的成本效益阈值(设定为人均 GDP 的 1 到 3 倍)来确定最佳策略。此外,我们还进行了敏感性分析,以评估研究结果的稳健性:结果:以 FOLFOX 为基础的两种方案均占据绝对优势。相比之下,CAPOX 方案的成本为 2,811.11 美元,QALY 为 0.75。在CAPOX方案中加入曲妥珠单抗后,成本增加到6128美元,疗效提高到0.92 QALYs,每QALY的ICER为19089.94美元,是2022年人均GDP的2至3倍:结论:在化疗方案中加入曲妥珠单抗可改善HER2阳性胃癌患者的临床疗效。从经济角度看,当成本效益阈值为伊朗人均 GDP 的 2 倍时,CAPOX 方案是最具成本效益的方案。然而,当阈值增加到人均 GDP 的三倍时,CAPOX + 曲妥珠单抗方案成为首选。这些发现为伊朗的医疗决策者提供了宝贵的见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Trastuzumab plus chemotherapy versus chemotherapy alone in HER2-positive gastric cancer treatment in Iran: a cost-effectiveness analysis.

Background: Combining Trastuzumab with chemotherapy for HER2-positive gastric cancer shows treatment promise but may raise costs. We aimed to evaluate the cost-effectiveness of combining Trastuzumab with chemotherapy for HER2-positive gastric cancer treatment in Iran.

Methods: We employed a partitioned survival model (PSM) to evaluate the cost-effectiveness of trastuzumab plus chemotherapy versus chemotherapy alone. The PSM framework included three distinct health states: progression-free, post-progression, and death. Clinical data, including overall survival and progression-free survival rates, were derived from the ToGA trial, a randomized controlled study. A bottom-up approach was used to calculate costs by considering drug costs, adverse event management costs and other disease management costs separately for the progression-free and post-progression states. The analysis was conducted from the Iranian healthcare system's perspective, considering direct medical costs. We performed a cost-effectiveness analysis to determine the optimal strategy by comparing the incremental cost-effectiveness ratio (ICER) to Iran's cost-effectiveness threshold, set at one to three times the GDP per capita. Additionally, we conducted sensitivity analyses to assess the robustness of our findings.

Results: Both FOLFOX-based regimens were strongly dominated. In comparison, the CAPOX regimen cost $2,811.11 for 0.75 QALYs. Adding Trastuzumab to CAPOX increased the cost to $6,128 and improved effectiveness to 0.92 QALYs, resulting in an ICER of $19,089.94 per QALY, which is between 2 and 3 times the GDP per capita in 2022.

Conclusion: The addition of trastuzumab to chemotherapy regimens improved clinical outcomes in HER2-positive gastric cancer patients. From an economic perspective, the CAPOX regimen is the most cost-effective option when considering a cost-effectiveness threshold of up to two times Iran's GDP per capita. However, when the threshold increases to three times the GDP per capita, the CAPOX + Trastuzumab regimen becomes the preferred choice. These findings provide valuable insights for healthcare policymakers in Iran.

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来源期刊
CiteScore
3.90
自引率
4.20%
发文量
59
审稿时长
13 weeks
期刊介绍: Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
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