【摘要】 目的:从中国医疗保健系统角度和美国支付者角度出发，比较阿替利珠单抗联合贝伐珠单抗(AteBev)与拉非尼(Sor)在一线治疗不可切除肝细胞癌(uHCC)患者中的经济性。方法:基于Ⅲ期临床研究(IMbrave150)最新研究结果构建评价经济性的Markov模型和分区生存(PS)模型，循环周期为1个月，研究时限为10年。成本和效用来源于文献和数据库，转移概率和比例通过计算获得；模型主要结果包括总成本、总生命年(LYs)、总质量调整生命年(QALYs)和增量成本效果比(ICER)、增量净健康收益(INHB)、增量净货币收益(INMB)。通过将ICER值与意愿支付阈值(WTP)比较，判断两种方案的经济性。通过敏感性分析处理模型参数的不确定性。结果:基础分析中，从中国医疗保健系统角度出发，基于Markov模型和PS模型，AteBev方案相对于Sor方案的ICER值分别是138 462美元/QALY、137 056美元/QALY;从美国支付者角度出发，基于Markov模型和PS模型，AteBev方案相对于Sor方案的ICER值分别是492 241美元/QALY、485 804美元/QALY,ICER值均大于其意愿支付阈值(31 499美元/QALY、150 000美元/QALY),各种敏感性分析结果表明，基础分析结果稳定。结论:从中国医疗保健系统角度和美国支付者角度出发，在阈值为31 499美元/QALY、150 000美元/QALY时，Sor方案在一线治疗uHCC中更具经济性。更多还原

【Abstract】 Objective: To estimate the economic efficiency of atezolizumab plus bevacizumab(AteBev) versus sorafenib(Sor) in the first-line treatment of unresectable hepatocellular carcinoma from the perspective of Chinese healthcare system and that of U.S. payers. Methods: A Markov model and a partitioned survival model with 1 month cycle in 10 years horizon were adopted based on a phase Ⅲ clinical trial(IMbrave150). Costs and utility values were derived from literature and databases. The transition probabilities and proportions were estimated by calculation. Total costs, total life years(LYs), total quality adjusted life years(QALYs), incremental cost-effectiveness ratios(ICER), incremental net health benefits(INHB) and incremental net monetary benefits(INMB) were main outputs of the models. The economics of two strategies were judged by comparing the ICER values with the willingness-to-pay thresholds. To handle with the uncertainty of model parameters, sensitivity analyses were performed.Results: From the perspective of Chinese healthcare system, the base-case estimates of ICERs for AteBev versus Sor in the Markov model and partitioned survival model were 138 462 dollars/QALY and 137 056 dollars/QALY, respectively. From the perspective of U.S. payers, the base-case estimates of ICERs for AteBev versus Sor in the Markov model and partitioned survival model were 492 241 dollars/QALY and 485 804 dollars/QALY, respectively. All ICERs exceeded the willing-to-pay thresholds of 31 499 dollars/QALY and 150 000 dollars/QALY. All sensitivity analyses confirmed that the base-case results were stable. Conclusion: From the perspective of Chinese healthcare system and that of U.S. payers, Sor is more economical in the first-line treatment of unresectable hepatocellular carcinoma compared with AteBev at the adopted thresholds of 31 499 dollars/QALY and 150 000 dollars/QALY.更多还原