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在越南,不可切除的 III 期非小细胞肺癌巩固治疗度伐利尤单抗的成本效益。

Cost-effectiveness of consolidation durvalumab for inoperable stage III non-small cell lung cancer in Vietnam.

机构信息

Epidemiology and Global Public Health, Umea Universitet, Umea, Sweden

Hanoi University of Public Health, Hanoi, Viet Nam.

出版信息

BMJ Open. 2024 Aug 30;14(8):e083895. doi: 10.1136/bmjopen-2024-083895.

Abstract

BACKGROUND

This study aimed to assess the cost-effectiveness of durvalumab as a treatment option for patients with inoperable stage III non-small cell lung cancer (NSCLC) from healthcare and partial societal perspectives in Vietnam.

METHOD

A lifetime partitioned survival model was used to evaluate the costs and quality-adjusted life years (QALYs) associated with consolidation durvalumab in comparison with the standard of care alone. Local costs and utilities were incorporated into the model. In the base-case analysis, no discount was applied to the acquisition cost of durvalumab. Scenario-based, one-way and probabilistic-sensitivity analyses were conducted.

RESULTS

The base-case analysis revealed that the intervention resulted in an increase of 1.38 life years or 1.08 QALYs for patients, but the intervention was not deemed cost-effective from either perspective in the base-case analysis. However, with a 70% reduction in the durvalumab acquisition cost, the intervention was observed to be cost-effective when evaluated from a healthcare perspective and when examining the undiscounted results from a partial societal standpoint.

CONCLUSION

This study provides evidence regarding the cost-effectiveness of durvalumab for the treatment of inoperable stage III NSCLC in Vietnam for various scenarios. The intervention was not cost-effective at full acquisition cost, but it is important to acknowledge that cost-effectiveness arguments alone cannot solely guide decision-makers in Vietnam; other criteria, such as budget impact and ethical concerns, are crucial factors to consider in decision-making processes.

摘要

背景

本研究旨在从医疗保健和部分社会角度评估度伐利尤单抗作为越南不可切除 III 期非小细胞肺癌(NSCLC)患者治疗选择的成本效益。

方法

使用终生分割生存模型来评估巩固治疗中使用度伐利尤单抗与单独使用标准护理相关的成本和质量调整生命年(QALY)。模型中纳入了当地的成本和效用数据。在基准分析中,未对度伐利尤单抗的获得成本进行折扣。进行了基于情景的、单向和概率敏感性分析。

结果

基准分析表明,该干预措施使患者的生命延长了 1.38 年或 QALY 延长了 1.08 年,但在基准分析中,从两种观点来看,该干预措施均不具有成本效益。然而,当度伐利尤单抗的获得成本降低 70%时,从医疗保健角度评估和从部分社会角度评估未贴现结果时,该干预措施被认为具有成本效益。

结论

本研究为度伐利尤单抗治疗越南不可切除 III 期 NSCLC 的成本效益提供了证据,针对各种情况进行了研究。在全额获得成本下,该干预措施不具有成本效益,但需要认识到,在越南,成本效益论证本身不能单独作为决策者的唯一指导;其他标准,如预算影响和伦理问题,是决策过程中需要考虑的关键因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9b71/11407225/370859ff1b9e/bmjopen-14-8-g001.jpg

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