基于两种模型的帕博利珠单抗联合化疗一线 治疗晚期胆道癌的经济学评价.

OBJECTIVE: To evaluate the economic impact of pembrolizumab combined with gemcitabine and cisplatin versus placebo combined with gemcitabine and cisplatin for the first-line treatment of patients with advanced biliary tract cancer in China. METHODS: From the perspective of China’ s health system, the willingness-to-pay (WTP) threshold was set at 3 times of China’ s gross domestic product ( GDP) per capita in 2022, that is 257 094. 00 RMB/ quality-adjusted life year (QALY), Markov model and partitioned survival model were constructed to conduct cost-effectiveness analysis, univariate sensitivity analysis and probabilistic sensitivity analysis were used to analyze the effects of parameters on the model’s robustness, and to analyze the economic outcome of pembrolizumab under the patient assistance program scenario. RESULTS: The results of Markov model analysis showed that the incremental cost-effectiveness ratio (ICER) was 2 758 043. 34 RMB/QALY for the pembrolizumab group versus the placebo group, and 730 319. 70 RMB/QALY under the patient assistance program scenario, which were both higher than the set WTP threshold; in the absence of patient assistance program, the cost-effectiveness price of pembrolizumab was 1 452. 45 RMB/100 mg, and the partitioned survival model results had validated the Markov model results. CONCLUSIONS: Under the WTP threshold of 3 times of 2022 China’s per capita GDP, pembrolizumab combined with chemotherapy for the first-line treatment of advanced biliary tract cancer does not have cost-effectiveness advantage, and lowering the price of pembrolizumab can increase the probability of its cost-effectiveness advantage. [ABSTRACT FROM AUTHOR]