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在BCG不响应的NMIBC中对不同治疗方式的成本效益分析

Constantin Rieger¹, Jörg Schlüchtermann², Enno Storz¹

¹Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany.

BJU international

|March 16, 2024

概括

对于BCG不响应的NMIBC,激进囊切除术是标准的,但像Gemcitabine/Docetaxel和HIVEC这样的救援疗法提供了具有成本效益的膀保护. 布罗利祖马布需要大幅降低价格才能具有成本效益.

科学领域:

尿瘤学尿瘤学
卫生经济学卫生经济学
药物经济学药物经济学

背景情况:

激进囊切除术 (RC) 是对BCG不响应的非肌肉侵入性膀癌 (NMIBC) 的标准护理,但它显著影响生活质量.
拯救疗法,包括吉姆西塔/多塞塔克塞尔,布罗利祖马布和高热性静脉内化学疗法 (HIVEC),正在成为节省膀的选择.

研究的目的:

对BCG不响应的NMIBC进行救援疗法的成本效益分析.
为了比较gemcitabine / docetaxel, pembrolizumab和HIVEC与激进囊切除术的成本,以每年的质量调整寿命 (QALY) 计算.

主要方法:

从付款人的角度开发了一个马尔科夫模型.
使用了单臂试验和泌尿瘤中心的临床数据.
蒙特卡罗模拟被用来确定增量成本效益比率 (ICER) 在50,000欧元/QALY的支付意愿门.

主要成果:

在10年的时间里,吉姆西塔/多塞塔克塞尔,HIVEC和庞布利祖马布的费用为48,353欧元,64438欧元和204,580欧元,分别获得6.16,6.48和6.00个QALY.
RC的成本为21,871欧元,获得了5.01个QALY.
在5万欧元/QALY支付意愿门以下,HIVEC被确定为首选的治疗方法.

结论:

对于BCG耐火性NMIBC来说,吉姆西塔/多塞和HIVEC的成本效益非常高,其支付意愿为<50,000欧元/QALY.
彻底的囊切除术仍然是最便宜的选择.
布罗利祖马布的成本效益取决于至少70%的价格降低.

关键词:

没有反应的BCG.艾滋病毒艾滋病毒艾滋病毒EC HIVEC 膀癌:膀癌是一种癌症.经济效益性成本效益性这就是Pembrolizumab.

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