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Liang X, Meng M, Qin S, Chen X, Li Y. First-line serplulimab plus chemotherapy versus chemotherapy in PD-L1-positive esophageal squamous-cell carcinoma: a cost-effectiveness analysis. Sci Rep 2024; 14:14496. [PMID: 38914660 PMCID: PMC11196723 DOI: 10.1038/s41598-024-65474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/20/2024] [Indexed: 06/26/2024] Open
Abstract
Patients with PD-L1-positive esophageal squamous-cell carcinoma (ESCC) were significantly more likely to survive when treated with serplulimab plus cisplatin plus 5-fluorouracil (serplulimab-CF). At this point, it is unknown whether this expensive therapy is cost-effective. From the Chinese healthcare system's perspective, we aimed to evaluate serplulimab-CF versus CF alone for cost-effectiveness. A partitioned survival model was constructed based on the ASTRUM-007 trial. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. A further analysis of subgroups and scenarios was conducted. The willingness to pay (WTP) threshold of $38,258/QALY or $84,866/QALY is defined as three times the per capita gross domestic product value of the general region or affluent region. Compared with CF alone, in the overall (scenario 1), patients with PD-L1 expression level of 1 ≤ CPS < 10 (scenario 2), and patients with PD-L1 CPS ≥ 10 (scenario 3) populations, the ICERs were $69,025/QALY, $82,533/QALY, and $75,436/QALY for serplulimab-CF. Nevertheless, the probability of serplulimab-CF becoming cost-effective based on scenarios 1, 2, and 3 is only 2.71%, 0.94%, and 2.84%, respectively, at a WTP threshold of $38,258/QALY. When serplulimab costs < $4.84/mg, serplulimab-CF may be cost-effective at the WTP threshold of $38,258/QALY; otherwise, CF was preferred. Similar results were obtained from sensitivity analyses, suggesting the robustness of these findings. There was no cost-effectiveness in general regions of China for serplulimab-CF in PD-L1-positive ESCC compared to CF, although it is probably considered cost-effective in affluent regions. Serplulimab-CF may achieve favorable cost-effectiveness by lowering the price of serplulimab.
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Affiliation(s)
- Xueyan Liang
- Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China
| | - Mingyu Meng
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China
| | - Shiran Qin
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China
| | - Xiaoyu Chen
- Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China.
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China.
| | - Yan Li
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China.
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Li F, Chen Y, Xiao D, Jiang S, Yang Y. Cost-Effectiveness Analysis of Sintilimab Plus Chemotherapy in Advanced Non-Squamous Non-Small Cell Lung Cancer: A Societal Perspective. Adv Ther 2024; 41:1436-1449. [PMID: 38356107 DOI: 10.1007/s12325-024-02808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION The updated ORIENT-11 study demonstrated that sintilimab, when combined with chemotherapy, had promising survival advantage compared to standard chemotherapy alone in the first-line treatment for previously untreated, locally advanced or metastatic non-squamous non-small cell lung cancer (nsNSCLC). This study aims to evaluate the cost-effectiveness of sintilimab plus chemotherapy for advanced nsNSCLC from a Chinese societal perspective. METHODS A partitioned survival model with a embedded decision tree was developed to assess the economic value of sintilimab plus chemotherapy over a lifetime horizon. Clinical data was captured from the updated ORIENT-11 study, while costs, health productivity losses, and utility values were collected from a nationwide cross-sectional survey in tertiary hospitals across multiple provinces in China. The primary outcomes were measured using the metrics of quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Costs and health outcomes were discounted at an annual rate of 5% per annum. Sensitivity analyses, including one-way and probabilistic sensitivity analyses, subgroup analyses, and scenario analyses, were performed. RESULTS Compared to standard chemotherapy, treatment with sintilimab plus chemotherapy incurred a mean total cost of $23,979 and gained 0.98 QALYs over the lifetime horizon, resulting in an ICER of $24,568 per QALY gained. The use of sintilimab accumulated direct non-medical costs of $9262 and indirect costs of $6780 over 16 years. Probabilistic sensitivity analyses showed an 84.2% probability of sintilimab plus chemotherapy being cost-effective at a threshold of three times China's per capita gross domestic product in 2022 ($38,201). The model was most sensitive to the discount rate of QALYs and costs, as well as the costs of pemetrexed, sintilimab, and subsequent therapy in progressive disease state. Subgroup analyses indicated favorable incremental net monetary benefits in all subgroups. CONCLUSION Sintilimab plus chemotherapy is a cost-effective first-line treatment therapy for advanced nsNSCLC in China when compared to standard chemotherapy. These findings, along with the improved progression-free survival and overall survival (OS) observed in ORIENT-11, support the use of this regimen in eligible candidates for advanced nsNSCLC.
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Affiliation(s)
- Fuming Li
- School of Public Health, Fudan University, Shanghai, People's Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, People's Republic of China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, People's Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, People's Republic of China
| | - Dunming Xiao
- School of Public Health, Fudan University, Shanghai, People's Republic of China
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, People's Republic of China
| | - Shan Jiang
- Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Yi Yang
- School of Public Health, Fudan University, Shanghai, People's Republic of China.
- National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, People's Republic of China.
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He Z, Huang X, Chen D, Wang G, Zhu Y, Li H, Han S, Shi L, Guan X. Sponsorship bias in published pharmacoeconomic evaluations of national reimbursement negotiation drugs in China: a systematic review. BMJ Glob Health 2023; 8:e012780. [PMID: 38030227 PMCID: PMC10689407 DOI: 10.1136/bmjgh-2023-012780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND China's National Reimbursement Drug List (NRDL) has become the primary route for drug reimbursement in China. More recently, the authority has made pharmacoeconomic evaluation an integral part of the application for NRDL inclusion. The underlying financial conflict of interests (FCOI) of pharmacoeconomic evaluations, however, has the potential to influence evidence generated and thus subsequent decision-making yet remains poorly understood. METHODS We searched for studies published between January 2012 and January 2022 on the 174 drugs added to the 2017-2020 NRDLs after successful negotiation. We categorised the study's FCOI status into no funding, industry funding, non-profit funding and multiple fundings based on authors' disclosure and assessed the reporting quality of included studies using the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. We compiled descriptive statistics of funding types and study outcomes using t-tests and χ2 tests and conducted multivariate regression analysis. RESULTS We identified 378 records and our final sample included 92 pharmacoeconomic evaluations, among which 69.6% were conducted with at least one funding source. More than half (57.6%) of the evaluations reached favourable conclusions towards the intervention drug and 12.6% reached a dominant result of the intervention drug over the comparison from model simulation. The reporting quality of included studies ranged from 19 to 25 (on a scale of 28), with an average of 22.3. The statistical tests indicated that industry-funded studies were significantly more likely to conclude that the intervention therapy was economical (p<0.01) and had a significantly higher proportion of resulting target drug economically dominated the comparison drug (p<0.05). CONCLUSION The study revealed that FCOI bias is common in published pharmacoeconomic evaluations conducted in Chinese settings and could significantly influence the study's economical results and conclusions through various mechanisms. Multifaceted efforts are needed to improve transparency, comparability and reporting standardisation.
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Affiliation(s)
- Zixuan He
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xianqin Huang
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Dingyi Chen
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Guoan Wang
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Yuezhen Zhu
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Sheng Han
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Luwen Shi
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- International Research Center for Medicinal Administration, Peking University, Beijing, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
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Liang X, Chen X, Li H, Li Y. Cost-effectiveness of camrelizumab plus chemotherapy in advanced squamous non-small-cell lung cancer. Immunotherapy 2023; 15:1133-1142. [PMID: 37492009 DOI: 10.2217/imt-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Objectives: A cost-effectiveness study of camrelizumab plus chemotherapy for advanced squamous non-small-cell lung cancer in China was conducted versus chemotherapy alone. Methods: Survival data were derived from CameL-Sq. Cost-effectiveness is indicated by an incremental cost-effectiveness ratio (ICER) less than the willingness-to-pay threshold. The partitioned survival model stability was assessed by sensitivity analyses. Results: With camrelizumab plus chemotherapy, quality-adjusted life years increased by 0.83, and cost increased by $21,259/patient versus chemotherapy. The ICER was $25,674/quality-adjusted life year. The probability of cost-effectiveness was >90% regardless of PD-L1 expression level. Regardless of the variation in each parameter across a wide range, the ICER never transcended the willingness to pay. Conclusion: Camrelizumab plus chemotherapy is a cost-effective first-line treatment for advanced squamous non-small cell lung cancer in China.
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Affiliation(s)
- Xueyan Liang
- Phase I Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Xiaoyu Chen
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Huijuan Li
- Phase I Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Yan Li
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
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Liang X, Chen X, Li H, Li Y. Cost-effectiveness analysis of first-line serplulimab combined with chemotherapy for extensive-stage small cell lung cancer. Front Public Health 2023; 11:1156427. [PMID: 37727602 PMCID: PMC10505963 DOI: 10.3389/fpubh.2023.1156427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Background For patients with extensive-stage small cell lung cancer (ES-SCLC), serplulimab plus chemotherapy is beneficial as the first-line treatment. It is uncertain whether serplulimab plus chemotherapy will be more cost-effective. The aim of this study was to evaluate from the perspective of the Chinese healthcare system to assess the cost-effectiveness of serplulimab plus chemotherapy for patients with ES-SCLC. Materials and methods This study employed a partitioned survival model. Patients in the model were selected from ASTRUM-005 for their clinical characteristics and outcomes. In order to assess the robustness of the model, we conducted deterministic one-way sensitivity analyzes as well as probabilistic sensitivity analyzes. Subgroup analyzes were also conducted. Costs, quality-adjusted life-years (QALYs), life-years, incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB), and incremental net monetary benefits (INMB) were analyzed. Results Based on the base-case analysis, serplulimab plus chemotherapy contributed to an increase in 0.826 life-years and 0.436 QALYs; an incremental cost of $52,331, yielded ICER of $120,149/QALY. Based on the willingness to pay (WTP) threshold of $37,669/QALY and $86,569/QALY, the INHB was -0.954 QALYs and - 0.169 QALYs and the INMB was -$35,924 and -$14,626, respectively. Based on the probabilistic sensitivity analysis results, serplulimab plus chemotherapy was unlikely to be cost-effective at a WTP threshold of $37,669/QALY and $86,569/QALY. One-way sensitivity analysis indicated that cost of serplulimab and body weight had the greatest impact on the model. Serplulimab plus chemotherapy could be cost-effective at a WTP threshold of $86,569/QALY when the cost of serplulimab was less than $5.24/mg or when the weight of the patient was less than 40.96 kg. Regardless of the WTP threshold at $37,669/QALY or $86,569. Serplulimab plus chemotherapy was not cost-effective in all subgroups. Conclusion Serplulimab plus chemotherapy was not cost-effective, despite having a prior clinical benefical and a relative safety profile compared with chemotherapy. With the reduction in the price of serplulimab, ES-SCLC patients treated with serplulimab plus chemotherapy may be able to achieve a favorable cost-effectiveness rate.
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Affiliation(s)
- Xueyan Liang
- Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xiaoyu Chen
- Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Huijuan Li
- Phase 1 Clinical Trial Laboratory, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yan Li
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Hu S, Tang Z, Harrison JP, Hertel N, Penrod JR, May JR, Juarez-Garcia A, Holdgate O. Economic Evaluation of Nivolumab Versus Docetaxel for the Treatment of Advanced Squamous and Non-squamous Non-small Cell Lung Cancer After Prior Chemotherapy in China. PHARMACOECONOMICS - OPEN 2023; 7:273-284. [PMID: 36897427 PMCID: PMC10043099 DOI: 10.1007/s41669-022-00383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To evaluate the economic value of nivolumab versus docetaxel for advanced non-small cell lung cancer (aNSCLC) treatment after platinum-based chemotherapy in adults without epidermal growth factor receptor/anaplastic lymphoma kinase aberrations in China. METHODS Partitioned survival models evaluated lifetime costs and benefits of nivolumab versus docetaxel by squamous and non-squamous histologies from a Chinese healthcare payer perspective. Progression-free disease, progressed disease, and death health states were considered over a 20-year time horizon. Clinical data were derived from the CheckMate pivotal Phase III trials (ClinicalTrials.gov identifiers: NCT01642004, NCT01673867, NCT02613507); patient-level survival data were extrapolated using parametric functions. China-specific health state utilities, healthcare resource utilisation, and unit costs were applied. Sensitivity analyses explored uncertainty. RESULTS Nivolumab resulted in extended survival (1.489 and 1.228 life-years [1.226 and 0.995 discounted]) and quality-adjusted survival benefits (1.034 and 0.833 quality-adjusted life-years) at additional costs of ¥214,353 (US$31,829) and ¥158,993 (US$23,608) versus docetaxel in squamous and non-squamous aNSCLC, respectively. Nivolumab was associated with higher acquisition costs, lower subsequent treatment costs, and lower adverse event management costs than docetaxel in both histologies. Drug acquisition costs, discount rate for outcomes, and average body weight were key model drivers. Stochastic results aligned with the deterministic results. CONCLUSIONS Nivolumab yielded survival and quality-adjusted survival benefits at incremental cost versus docetaxel in aNSCLC. As a traditional healthcare payer perspective was applied, the true economic benefit of nivolumab may be underestimated as not all treatment benefits and costs of relevance to society were considered.
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Affiliation(s)
- Shanlian Hu
- School of Public Health, Fudan University, Dong'an Rd, Xuhui Qu, Shanghai, 200333, China
| | - Zhiliu Tang
- Sino-American Shanghai Squibb Pharmaceuticals Ltd, 1315 Jianchuan Rd, Minhang Qu, Shanghai, 201401, China.
- GlaxoSmithKline China, 6/F The Headquarters Building, 168 Tibet Rd(M), Shanghai, 200001, China.
| | - James P Harrison
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, USA
| | - Nadine Hertel
- Bristol Myers Squibb, Sanderson Rd, Uxbridge, UB8 1DH, UK
| | - John R Penrod
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, USA
| | - Jessica R May
- Bristol Myers Squibb, Sanderson Rd, Uxbridge, UB8 1DH, UK
| | | | - Orban Holdgate
- Parexel International, Evergreen House North, Grafton Place, 160 Euston Road, London, NW1 2DX, UK
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Liang X, Chen X, Li H, Li Y. Tislelizumab plus chemotherapy is more cost-effective than chemotherapy alone as first-line therapy for advanced non-squamous non-small cell lung cancer. Front Public Health 2023; 11:1009920. [PMID: 36794070 PMCID: PMC9922748 DOI: 10.3389/fpubh.2023.1009920] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023] Open
Abstract
Background and objective Tislelizumab is a programmed cell death protein-1 (PD-1) inhibitor. Tislelizumab plus chemotherapy as first-line option for advanced non-squamous non-small cell lung cancer (NSCLC), compared with chemotherapy alone, resulted in significantly prolonged survival outcomes; however, evidence regarding its relative efficacy and cost is lacking. We aimed to evaluate the cost-effectiveness of tislelizumab plus chemotherapy compared with that of chemotherapy alone, from the health care perspective in China. Methods A partitioned survival model (PSM) was used for this study. The survival data were obtained from the RATIONALE 304 trial. Cost-effectiveness was defined as incremental cost-effectiveness ratio (ICER) less than the willingness to pay (WTP) threshold. Incremental net health benefits (INHB), incremental net monetary benefits (INMB), and subgroup analyses were also assessed. Sensitivity analyses were further established to assess the model stability. Results Compared with chemotherapy alone, tislelizumab plus chemotherapy increased by 0.64 quality-adjusted life-years (QALYs) and 1.48 life-years, and yielded an increase of $16,631 in cost per patient. The INMB and INHB were $7,510 and 0.20 QALYs at a WTP threshold of $38,017/QALY, respectively. The ICER was $26,162/QALY. The outcomes were most sensitive to the HR of OS for tislelizumab plus chemotherapy arm. The probability of tislelizumab plus chemotherapy being considered cost-effective was 87.66% and >50% in most of the subgroups at the WTP threshold of $38,017/QALY. At the WTP threshold of $86,376/QALY, the probability achieved 99.81%. Furthermore, the probability of tislelizumab plus chemotherapy being considered cost-effective in subgroups of patients with liver metastases and PD-L1 expression ≥50% were 90.61 and 94.35%, respectively. Conclusion Tislelizumab plus chemotherapy is likely to be cost-effective as a first-line treatment for advanced non-squamous NSCLC in China.
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Affiliation(s)
| | | | | | - Yan Li
- *Correspondence: Yan Li ✉
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Liang X, Chen X, Li H, Liu X, Li Y. Sugemalimab plus chemotherapy vs. chemotherapy for metastatic non-small-cell lung cancer: A cost-effectiveness analysis. Front Public Health 2023; 11:1054405. [PMID: 36923040 PMCID: PMC10008846 DOI: 10.3389/fpubh.2023.1054405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
Background Sugemalimab is a newly developed inhibitor of programmed death ligand 1 (PD-L1). As a first-line treatment for metastatic non-small-cell lung cancer (NSCLC), sugemalimab plus chemotherapy (Sugema-Chemo) has been proven effective. Still, its cost-effectiveness has not yet been determined. The objective of this study was to assess the cost-effectiveness of Sugema-Chemo from a health care perspective in China. Methods A partitioned survival model was used. According to the GEMSTONE-302 trial, the clinical characteristics and outcomes of the patients were obtained. The outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB) and incremental net monetary benefits (INMB). The robustness of the model was further evaluated, as well as subgroup analyses. When the ICER was lower than the willingness to pay (WTP) threshold ($38,017/QALY or $86,376/QALY, defined as three times the per capita gross domestic product value of the general region and Beijing), the cost-effectiveness of Sugema-Chemo was assumed for general regions or Beijing. Results Compared with chemotherapy alone, Sugema-Chemo resulted in an incremental gain of 0.82 QALYs, an incremental gain of 1.26 life-years, as well as an average increase cost of $72,472. The ICER was $88,744/QALY. Model outcomes were susceptible to average body weight and cost of sugemalimab. Sugema-Chemo was cost-effective at a WTP threshold of 86,376/QALY if the average body weight was <62.44 kg or if the price of sugemalimab was <$2.996/mg. As well, Sugema-Chemo was also cost-effective when the cost of sugemalimab was <$1.839/mg for a WTP threshold of $38,017/QALY. Sugema-Chemo had a probability of > 50% being considered cost-effective in most subgroups at the $86,376/QALY threshold. However, Sugema-Chemo did not achieve cost-effectiveness (0%) in any of the subgroups when WTP was set at $38,017/QALY. Conclusion Sugema-Chemo might not be cost-effective in patients with metastatic NSCLC in China. In deciding between Sugema-Chemo and chemotherapy alone, it is essential to consider both the body weight of patients and the price of sugemalimab. A price reduction of sugemalimab under the National Healthcare Security Administration may be an effective measure to improve the cost-effectiveness of the drug.
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Affiliation(s)
- Xueyan Liang
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xiaoyu Chen
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Huijuan Li
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xiaoxia Liu
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yan Li
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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Liu L, Jiang Z, Li F, Wei Y, Ming J, Yang Y, Liu S, Shi L, Chen Y. Were economic evaluations well reported for the newly listed oncology drugs in China's national reimbursement drug list. BMC Health Serv Res 2022; 22:1475. [PMID: 36463141 PMCID: PMC9719239 DOI: 10.1186/s12913-022-08858-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE To assess the reporting quality of published economic evaluations of the negotiated oncology drugs listed for China's 2020 National Reimbursement Drug List (NRDL). METHODS A comprehensive search was conducted to identify economic evaluation studies of negotiated oncology drugs listed in China's 2020 NRDL using the PubMed/MEDLINE, Embase, Web of Science, CNKI, SinoMed, and WanFang Database up to March 31, 2021. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist scored the reporting quality between 0 and 100. A linear regression analysis was employed to examine the influence of various characteristics on the reporting quality scores. RESULTS Eighty papers were included in the study, with the majority published during the past decade. Furthermore, more than half of the articles (57.5%, or 46 out of 80) were written in English. The average CHEERS score was 74.63 ± 12.75 and ranged from 43.48 to 93.75. The most inadequately reported items included choice of model, characterization of heterogeneity, and discussion, as well as currency, price date and conversion. Higher scores were associated with articles published from 2019 to 2021 and English publications. CONCLUSION The economic evaluation studies of negotiated oncology drugs listed in 2020 NRDL had moderate reporting quality. The Chinese economic evaluation publications could improve the reporting quality if the CHEERS checklist is consistently implemented. Also, the Chinese journals maybe explore introducing a reporting standard for economic evaluations.
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Affiliation(s)
- Liu Liu
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Zhixin Jiang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Fuming Li
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Yan Wei
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Jian Ming
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China ,Real World Solutions, IQVIA China, Shanghai, China
| | - Yi Yang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Shimeng Liu
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
| | - Lizheng Shi
- grid.265219.b0000 0001 2217 8588School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA USA
| | - Yingyao Chen
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, China
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Verschraegen C, Andric Z, Moiseenko F, Makharadze T, Shevnya S, Oleksiienko A, Yañez Ruiz E, Kim S, Ahn K, Park T, Park S, Ju H, Ohe Y. Candidate Bevacizumab Biosimilar CT-P16 versus European Union Reference Bevacizumab in Patients with Metastatic or Recurrent Non-Small Cell Lung Cancer: A Randomized Controlled Trial. BioDrugs 2022; 36:749-760. [PMID: 36169807 DOI: 10.1007/s40259-022-00552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND CT-P16 is a candidate bevacizumab biosimilar. OBJECTIVE This double-blind, multicenter, parallel-group, phase III study aimed to establish equivalent efficacy between CT-P16 and European Union-approved reference bevacizumab (EU-bevacizumab) in patients with metastatic or recurrent non-squamous non-small cell lung cancer (nsNSCLC). PATIENTS AND METHODS Patients with stage IV or recurrent nsNSCLC were randomized (1:1) to receive CT-P16 or EU-bevacizumab (15 mg/kg every 3 weeks; ≤ 6 cycles) with paclitaxel (200 mg/m2) and carboplatin (area under the curve 6.0; both for 4-6 cycles), as induction therapy. Patients with controlled disease after induction therapy continued with CT-P16 or EU-bevacizumab maintenance therapy. The primary endpoint was objective response rate (ORR) during the induction period. Time-to-event analyses, pharmacokinetics, safety, and immunogenicity were also evaluated. Results obtained after 1 year of follow-up are presented. RESULTS Overall, 689 patients were randomized (CT-P16, N = 342; EU-bevacizumab, N = 347). ORR was 42.40% (95% confidence interval [CI] 37.16-47.64) and 42.07% (95% CI 36.88-47.27) for CT-P16 and EU-bevacizumab, respectively. The risk difference (0.40 [95% CI - 7.02 to 7.83]) and risk ratio (1.0136 [90% CI 0.8767-1.1719]) for ORR fell within predefined equivalence margins (- 12.5 to + 12.5%, and 0.7368 to 1.3572, respectively), demonstrating equivalence between CT-P16 and EU-bevacizumab. Median response duration, time to progression, progression-free survival, and overall survival were comparable between treatment groups. Safety profiles were similar: 96.2% (CT-P16) and 93.0% (EU-bevacizumab) of patients experienced treatment-emergent adverse events. Pharmacokinetics and immunogenicity were comparable between groups. CONCLUSIONS Equivalent efficacy and similar pharmacokinetics, safety, and immunogenicity support bioequivalence of CT-P16 and EU-bevacizumab in patients with nsNSCLC. TRIAL REGISTRATION NUMBER NCT03676192.
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Affiliation(s)
- Claire Verschraegen
- The Ohio State University Comprehensive Cancer Center, 1800 Cannon Road - Lincoln Tower 1300, Columbus, OH, 43210, USA
| | - Zoran Andric
- Clinical Hospital Center Bezanijska Kosa, Dr Zorza Matea bb, Belgrade, 11000, Serbia
| | - Fedor Moiseenko
- GBUZ Saint Petersburg Clinical Research Center of Specialized Types of Care (Oncology) - Hospital, Ulitsa Leningradskaya 68a Litera A, Poselok Pesochny, St Petersburg, Leningradskaya Oblast, 197758, Russian Federation
| | - Tamta Makharadze
- LTD "High Technology Hospital Medcenter", 118 Pushkini Street, Batumi, 6000, Georgia
| | - Sergii Shevnya
- Communal Nonprofit Enterprise Podilsky Regional Center of Oncology of the Vinnytsia Regional Council, 84 Khmelnytske Road, Vinnytsia, 21029, Ukraine
| | - Alona Oleksiienko
- Treatment and Diagnostic Center of LLC Specialized Clinic Prognosis Optima, 40a Vatslava Havela Boulevard, Kyiv, 03126, Ukraine
| | - Eduardo Yañez Ruiz
- Department of Internal Medicine Oncology Unit - Hematology, School of Medicine, Universidad de la Frontera, Hochstetter 298, Temuco, 4800827, Chile
| | - SungHyun Kim
- Celltrion, Inc., 23 Academy-ro, Yeonsu-gu, Incheon, 22014, Republic of Korea
| | - KeumYoung Ahn
- Celltrion, Inc., 23 Academy-ro, Yeonsu-gu, Incheon, 22014, Republic of Korea
| | - TaeHong Park
- Celltrion, Inc., 23 Academy-ro, Yeonsu-gu, Incheon, 22014, Republic of Korea
| | - Sijin Park
- Celltrion, Inc., 23 Academy-ro, Yeonsu-gu, Incheon, 22014, Republic of Korea
| | - Hana Ju
- Celltrion, Inc., 23 Academy-ro, Yeonsu-gu, Incheon, 22014, Republic of Korea
| | - Yuichiro Ohe
- National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
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Chen R, Zhang Y, Lin K, Huang D, You M, Lai Y, Wang J, Hu Y, Li N. Cost-Effectiveness Analysis of Capecitabine Plus Oxaliplatin Versus Gemcitabine Plus Oxaliplatin as First-Line Therapy for Advanced Biliary Tract Cancers. Front Pharmacol 2022; 13:871262. [PMID: 35935821 PMCID: PMC9354395 DOI: 10.3389/fphar.2022.871262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In the first-line treatment of biliary tract cancers (BTCs), XELOX (capecitabine plus oxaliplatin) showed comparable clinical efficacy and safety to gemcitabine and oxaliplatin (GEMOX), with fewer visits and better treatment management. Our study aims to investigate the cost-effectiveness of XELOX and GEMOX as the first-line therapy for BTCs from the perspective of the Chinese healthcare systems and to provide valuable suggestions for clinical decision-making.Methods: A Markov model was developed using the phase 3 randomized clinical trial (ClinicalTrials.gov number, NCT01470443) to evaluate the cost-effectiveness of XELOX and GEMOX. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were used as the primary outcomes of the model. Uncertainty was assessed using univariate and probabilistic sensitivity analysis.Results: The QALYs for the XELOX and GEMOX groups were 0.66 and 0.54, respectively. In China, the total cost of XELOX treatment is US $12,275.51, which is lower than that of the GEMOX regimen. In addition, XELOX is more effective than GEMOX, making it the preferred regimen. A sensitivity analysis determined that XELOX therapy has a stable economic advantage in China.Conclusion: Compared to GEMOX, XELOX is a more cost-effective treatment as a first-line treatment for advanced BTC from the perspective of the Chinese health service system.
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Affiliation(s)
- Ruijia Chen
- Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yalan Zhang
- Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Kongying Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Defu Huang
- Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - MaoJin You
- Department of Pharmacy, Mindong Hospital of Fujian Medical University, Ningde, China
| | - Yanjin Lai
- Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jinye Wang
- Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Yingying Hu
- Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Yingying Hu, ; Na Li,
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
- *Correspondence: Yingying Hu, ; Na Li,
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12
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Luo X, Liu Q, Zhou Z, Yi L, Peng L, Wan X, Zeng X, Tan C, Li S. Cost-Effectiveness of Bevacizumab Biosimilar LY01008 Combined With Chemotherapy as First-Line Treatment for Chinese Patients With Advanced or Recurrent Nonsquamous Non-Small Cell Lung Cancer. Front Pharmacol 2022; 13:832215. [PMID: 35517823 PMCID: PMC9062292 DOI: 10.3389/fphar.2022.832215] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/10/2022] [Indexed: 01/15/2023] Open
Abstract
Objective: To investigate whether LY01008, a locally developed bevacizumab biosimilar agent, is appropriate for widespread use among Chinese advanced or recurrent nonsquamous non-small cell lung cancer (NSCLC) patients, our current study was designed to evaluate the cost-effectiveness of first-line LY01008 combined with platinum-doublet chemotherapy versus chemotherapy alone from the perspective of the Chinese healthcare system. Material and Methods: This economic evaluation designed a Markov model to compare the healthcare cost and quality-adjusted life-year (QALY) of first-line LY01008 combined with chemotherapy versus first-line chemotherapy. Transition probabilities, including disease progression, survival, and adverse event (AE)-related discontinuation of first-line treatment, were estimated using data from the clinical trials. Costs and health utilities were derived from local databases, hospitals, and published literature. Our base case analysis and scenario analysis focused on the cost-effectiveness of chemotherapy combined with a clinical trial dosage (15 mg/kg every 3-week cycle) and a real-world dosage (7.5 mg/kg every 3-week cycle) of LY01008, respectively. Results: In the base case analysis, first-line LY01008 combined with chemotherapy was associated with an increase of 0.48 QALYs in effectiveness and an increase of CNY 189,988 (US$ 26,240) in healthcare costs compared with first-line chemotherapy, resulting an incremental cost-effectiveness ratio (ICER) of CNY 375,425 (US$ 54,430)/QALY. In the scenario analysis, first-line LY01008 combined with chemotherapy was associated with a mean healthcare cost of CNY 265,060 (US$ 38,429), resulting an ICER of CNY 221,579 (US$ 32,125/QALY) between first-line LY01008 combined with chemotherapy versus first-line chemotherapy. The parameters that determine the cost of LY01008 have the greatest impact on the cost-effectiveness results. Conclusion: From the perspective of the Chinese healthcare system, first-line LY01008 at a real-world dosage combined with chemotherapy is likely to represent a cost-effective strategy compared with first-line chemotherapy alone for Chinese advanced or recurrent nonsquamous NSCLC patients.
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Affiliation(s)
- Xia Luo
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiao Liu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Lidan Yi
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liubao Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaomin Wan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaohui Zeng
- Department of Nuclear Medicine, PET Image Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chongqing Tan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sini Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
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13
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Zhu C, Xing XX, Wu B, Liang G, Han G, Lin CX, Fang HM. Cost-Effectiveness Analysis of Camrelizumab Plus Chemotherapy vs. Chemotherapy Alone as the First-Line Treatment in Patients With IIIB-IV Non-Squamous Non-Small Cell Lung Cancer (NSCLC) Without EGFR and ALK Alteration from a Perspective of Health - Care System in China. Front Pharmacol 2021; 12:735536. [PMID: 35002693 PMCID: PMC8740086 DOI: 10.3389/fphar.2021.735536] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: The CAMEL clinical trial (412 patients were randomly assigned to either camrelizumab plus chemotherapy (n = 205) or chemotherapy alone (n = 207)) demonstrated that camrelizumab plus chemotherapy (CC) improved the overall survival time (OS) and progression-free survival time (PFS) of patients with metastatic nonsquamous non-small cell lung cancer (non-sq NSCLC) without epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations (EGFRm and ALKm) vs. chemotherapy (C) alone. Our objective was to conduct a cost-effectiveness analysis of CC vs. C from a perspective of health - care system in China with a lifetime horizon to identify whether it will be cost-effective. Materials and Methods: A partitioned survival model (PSM) was applied for patients with IIIB-IV non-sq NSCLC without EGFRm and ALKm. Transition parameters and proportions of three health states were derived from the CAMEL trial. The model was designed using a lifetime horizon, a 21-day cycle, and a 5% discount rate of costs and outcomes. It was deemed cost-effective in China if the incremental cost-effectiveness ratio (ICER) value is less than $32,457 per quality adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses were performed to verify the influence of parameter uncertainty on the results. Results: In the base-case analysis, we found that the ICER of CC compared with C is $-7,382.72/QALY which meant that CC had lower costs and better outcomes. The results of the sensitivity analyses demonstrated that the result was robust for the ICERs never transcending the willingness-to-pay (WTP) threshold. Conclusion: Camrelizumab plus chemotherapy is an obviously cost-effective therapeutic regime for patients of IIIB-IV non-sq NSCLC without EGFRm and ALKm in China at a $32,457 WTP threshold.
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Affiliation(s)
- Chen Zhu
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-xuan Xing
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Gang Liang
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gang Han
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cai-xia Lin
- Department of Pharmacy, The People’s Hospital of Jiangshan, Jiangshan, China
| | - Hong-mei Fang
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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14
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Wan R, Dong X, Chen Q, Yu Y, Yang S, Zhang X, Zhang G, Pan Y, Sun S, Zhou C, Hong W, Zhao H, Yang L, Huang L, Wu R, Zang A, Ma R, Wu L, Lv D, Fu X, Han J, Li W, Duan J, Wang K, Jiang O, Chen Y, Guo Z, Gao H, Wen J, Wang S, Zhao E, Li G, Yue L, Liang L, Zeng A, Wang X, Zhu Y, Pan H, Dai Z, Feng W, Zhao G, Lin C, Li C, Li N, Bao Y, Li Y, Su Y, Zhao M, Fang H, Zhu Y, Zhang Y, Ding L, Wang Y, Yuan X, Wang J. Efficacy and safety of MIL60 compared with bevacizumab in advanced or recurrent non-squamous non-small cell lung cancer: a phase 3 randomized, double-blind study. EClinicalMedicine 2021; 42:101187. [PMID: 34841235 PMCID: PMC8606331 DOI: 10.1016/j.eclinm.2021.101187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND We compared the efficacy, safety, and immunogenicity of MIL60 with reference bevacizumab as first-line treatment in patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC) in this phase 3, randomized, double-blind study. METHODS Patients with untreated advanced or recurrent NSCLC were randomized (1:1 ratio) to receive either MIL60 or bevacizumab in combination with paclitaxel/carboplatin. Patients with non-progressive disease continued maintenance single-agent MIL60 until disease progression, or intolerable toxicity. The primary endpoint was the 12-week objective response rates (ORR12) by independent review committee (IRC) using RECIST 1.1. Bioequivalence was established if the ORR ratio located between 0.75 and 1/0.75. The trial was registered with clinicaltrials.gov (NCT03196986). FINDINGS Between Aug 23, 2017, and May 8, 2019, 517 patients were randomly assigned to MIL60 group (n=257) and bevacizumab group (n=260). In the full analysis set (FAS) population including all randomized and evaluable patients who received at least one dose of MIL60 or bevacizumab, the ORR12 in MIL60 group and bevacizumab group were 48.6% and 43.1%, respectively. The ORR ratio of these two groups were 1.14 (90% CI 0.97-1.33), which fell within the pre-specified equivalence boundaries (0.75-1/0.75). The median DOR was 5.7 months (95% CI 4.5-6.2) for MIL60 and 5.6 months (95% CI 4.3-6.4) for bevacizumab. No significant difference was noted in median PFS (7.2 vs. 8.1 months; HR 1.01, 95% CI 0.78-1.30, p=0.9606) and OS (19.3 vs. 16.3 months; HR 0.81, 95% CI 0.64-1.02, p=0.0755). Safety and tolerability profiles were similar between the two groups. No patient detected positive for Anti-drug antibody (ADA). INTERPRETATION The efficacy, safety and immunogenicity of MIL60 were similar with bevacizumab, providing an alternative treatment option for advanced or recurrent non-squamous NSCLC. FUNDING This study was sponsored by Betta Pharmaceutical Co., Ltd.
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Affiliation(s)
- Rui Wan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaorong Dong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qun Chen
- Medical Oncology, Fuzhou pulmonary Hospital of Fujian, Fuzhou, China
| | - Yan Yu
- Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shujun Yang
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaochun Zhang
- Cancer Precision Medicine Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guojun Zhang
- Respiratory Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yueyin Pan
- Department of Oncology Chemotherapy, the First Affiliated Hospital of USTC (Anhui Provincial Hospital), Hefei, China
| | - Sanyuan Sun
- Oncology, Xuzhou Central Hospital, Xuzhou, China
| | - Chengzhi Zhou
- Pulonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Hong
- Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Hui Zhao
- Respiratory, The Second Hospital of Anhui Medical University, Hefei, China
| | - Lei Yang
- Department of Respiratory Oncology, Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Linian Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Rong Wu
- Department of Internal Oncology II, Shengjing Hospital of China Medical University, Liaoning, China
| | - Aimin Zang
- Internal Medicine-Oncology, Affiliated Hospital of Hebei, Baoding, China
| | - Rui Ma
- Medical Oncology Department of Thoracic Cancer (II), Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, China
| | - Dongqing Lv
- Respiratory, Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Xiuhua Fu
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jianguo Han
- Oncology, Chifeng Municipal Hospital, Chifeng, China
| | - Wenxin Li
- Oncology, Inner Mongolia People's Hospital, Hohhot, China
| | - Jianchun Duan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kai Wang
- Respiratory, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Ou Jiang
- Department of Oncology, The Second People's Hospital of Neijiang, Neijiang, China
| | - Yinglan Chen
- Medical Oncology, Jiangxi Province Cancer Hospital, Nanchang, China
| | - Zhongliang Guo
- Department of Respiratory Medicine, Shanghai East Hospital, Shanghai, China
| | - Hongjun Gao
- Department of pulmonary oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Juyi Wen
- Department of Radiation Oncology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Shubin Wang
- Medical Oncology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Enfeng Zhao
- Three and Four Departments of Radiotherapy and Chemotherapy, Cangzhou Hospital of Integrated Traditional Chinese and Western of Hebei Province, Cangzhou, China
| | - Gaofeng Li
- Thoracic surgery, Yunnan Cancer Hospital, Kunming, China
| | - Lu Yue
- Oncology, Qingdao Municipal Hospital, Qingdao, China
| | - Li Liang
- Oncology, Peking University Third Hospital, Beijing, China
| | - Aiping Zeng
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoshan Wang
- Oncology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Yuxi Zhu
- Department of Oncology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hongming Pan
- Oncology Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoxia Dai
- Department of Thoracic Medical Oncology II, The Second Hospital of Dalian Medical University, Dalian, China
| | - Weineng Feng
- Head and Neck/Thoracic Medical Oncology, The First People's Hospital of Foshan, Foshan, China
| | - Guofang Zhao
- Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo No.2 Hospital), Ningbo, China
| | - Chuan Lin
- Oncology, Yibin Second People's Hospital, Yibin, China
| | - Chong Li
- Department of Respiratory Medicine, The First People's Hospital of Changzhou, Changzhou, China
| | - Na Li
- Department of Oncology, Suining Central Hospital, Suining, China
| | - Yangyi Bao
- Department of Oncology, The First People's Hospital of Hefei, Hefei, China
| | - Yinyin Li
- First Department of Oncology, Shenyang Chest Hospital, Shenyang, China
| | - Yanjun Su
- Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Min Zhao
- Oncology, Hebei Chest Hospital, Shijiazhuang, China
| | - Haohui Fang
- Respiratory, Anhui Chest Hospital, Hefei, China
| | - Yulong Zhu
- Department of Respiratory, Hospital of Traditional Chinese Medicine of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yu Zhang
- Respiratory, Nanjing Chest Hospital, Nanjing, China
| | - Lieming Ding
- Betta pharmaceuticals Co., Ltd., Hangzhou, China
| | - Yang Wang
- Betta pharmaceuticals Co., Ltd., Hangzhou, China
| | - Xiaobin Yuan
- Betta pharmaceuticals Co., Ltd., Hangzhou, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Corresponding Author: Jie Wang, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Shepard KB, Vodak DT, Kuehl PJ, Revelli D, Zhou Y, Pluntze AM, Adam MS, Oddo JC, Switala L, Cape JL, Baumann JM, Banks M. Local Treatment of Non-small Cell Lung Cancer with a Spray-Dried Bevacizumab Formulation. AAPS PharmSciTech 2021; 22:230. [PMID: 34467438 PMCID: PMC8408070 DOI: 10.1208/s12249-021-02095-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022] Open
Abstract
Local delivery of biotherapeutics to the lung holds great promise for treatment of lung diseases, but development of physically stable, biologically active dry powder formulations of large molecules for inhalation has remained a challenge. Here, spray drying was used to manufacture a dry powder pulmonary formulation of bevacizumab, a monoclonal antibody approved to treat non-small cell lung cancer (NSCLC) by intravenous infusion. By reformulating bevacizumab for local delivery, reduced side effects, lower doses, and improved patient compliance are possible. The formulation had aerosol properties suitable for delivery to the deep lung, as well as good physical stability at ambient temperature for at least 6 months. Bevacizumab’s anti-VEGF bioactivity was not impacted by the manufacturing process. The formulation was efficacious in an in vivo rat model for NSCLC at a 10-fold decrease in dose relative to the intravenous control.
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16
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Liu G, Kang S, Wang X, Shang F. Cost-Effectiveness Analysis of Atezolizumab Versus Chemotherapy as First-Line Treatment for Metastatic Non-Small-Cell Lung Cancer With Different PD-L1 Expression Status. Front Oncol 2021; 11:669195. [PMID: 33987103 PMCID: PMC8111076 DOI: 10.3389/fonc.2021.669195] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
Background Atezolizumab could significantly improve clinical outcomes and was associated with less toxicity compared with chemotherapy as the first-line treatment of PD-L1-selected patients with EGFR and ALK wild-type metastatic non-small-cell lung cancer (NSCLC). However, the economic outcomes remain unclear yet in China. This study aimed to investigate the cost-effectiveness of atezolizumab versus chemotherapy as first-line therapy for metastatic NSCLC with different PD-L1 expression status from the Chinese health sector perspective. Methods A decision-analytic model was conducted to evaluate the economic outcomes for the first-line treatment of EGFR and ALK wild-type metastatic NSCLC with atezolizumab and chemotherapy in high PD-L1 expression, high or intermediate PD-L1 expression and any PD-L1 expression populations, respectively. The efficacy and safety data were obtained from the IMpower110 trial. Cost and utility values were gathered from the local charges and published literatures. Incremental cost-effectiveness ratio (ICER) was estimated. A scenario analysis for a patient assistance program (PAP) was conducted. One-way and probabilistic sensitivity analyses were performed to explore the robustness of the model results. Results Atezolizumab yielded additional 0.91 QALYs, 0.57 QALYs, 0.42 QALYs in comparison with chemotherapy, and the ICERs were $123,778.60/QALY, $142,827.19/QALY, $168,902.66/QALY in the high PD-L1 expression, high or intermediate PD-L1 expression, and any PD-L1 expression populations, respectively. When PAP was available, the ICERs were $52,414.63/QALY, $52,329.73/QALY, $61,189.66/QALY in the three categories of PD-L1 expression status populations, respectively. The ICERs were exceed the willingness-to-pay (WTP) threshold of $30,828/QALY (three times of per capita gross domestic product of China in 2019) in China. One-way sensitivity analyses suggested that the cost of atezolizumab played a vital role in the model outcomes, and the probabilistic sensitivity analyses showed atezolizumab was unlikely to be cost-effective at the WTP threshold regardless of PD-L1 expression status and whether the PAP was available or not. Conclusions Atezolizumab as first-line treatment for PD-L1-selected metastatic NSCLC patients without EGFR mutations or ALK translocations is unlikely to be cost-effective compared with chemotherapy regardless of PD-L1 expression status in the Chinese context.
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Affiliation(s)
- Guoqiang Liu
- Department of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuo Kang
- Department of Pharmacy, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinchen Wang
- Laboratory of Pathology, Hebei Cancer Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fangjian Shang
- Department of General Surgery, Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, The First Hospital of Hebei Medical University, Shijiazhuang, China
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He X, You J, Ding H, Zhang Z, Cui L, Shen X, Bian X, Liu Y, Chen J. Vasculogenic mimicry, a negative indicator for progression free survival of lung adenocarcinoma irrespective of first line treatment and epithelial growth factor receptor mutation status. BMC Cancer 2021; 21:132. [PMID: 33549061 PMCID: PMC7866877 DOI: 10.1186/s12885-021-07863-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 02/01/2021] [Indexed: 12/19/2022] Open
Abstract
Background Vascular mimicry (VM) was associated with the prognosis of cancers. The aim of the study was to explore the association between VM and anticancer therapy response in patients with lung adenocarcinoma. Methods This was a single-center retrospective study of patients with lung adenocarcinoma between March 1st, 2013, to April 1st, 2019, at the Second People’s Hospital of Taizhou City. All included patients were divided into the VM and no-VM groups according to whether VM was observed or not in the specimen. Vessels with positive PAS and negative CD34 staining were confirmed as VM. The main outcome was progression-free survival (PFS). Results Sixty-six (50.4%) patients were male. Eighty-one patients received chemotherapy as the first-line treatment, and 50 patients received TKIs. Forty-five (34.4%) patients were confirmed with VM. There was no difference regarding the first-line treatment between the VM and no-VM groups (P = 0.285). The 86 patients without VM had a median PFS of 279 (range, 90–1095) days, and 45 patients with VM had a median PFS of 167 (range, 90–369) days (P < 0.001). T stage (hazard ratio (HR) = 1.37, 95% confidence interval (CI): 1.10–1.71), N stage (HR = 1.43, 95%CI: 1.09–1.86), M stage (HR = 2.85, 95%CI: 1.76–4.61), differentiation (HR = 1.85, 95%CI: 1.29–2.65), therapy (HR = 0.32, 95%CI: 0.21–0.49), VM (HR = 2.12, 95%CI: 1.33–3.37), and ECOG (HR = 1.41, 95%CI: 1.09–1.84) were independently associated with PFS. Conclusion The benefits of first-line TKIs for NSCLC with EGFR mutation are possibly better than those of platinum-based regimens in patients without VM, but there is no difference in the benefit of chemotherapy or target therapy for VM-positive NSCLC harboring EGFR mutations.
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Affiliation(s)
- Xuejun He
- Oncology Department, the Second People's Hospital of Taizhou affiliated to Medical College of Yangzhou University, No. 27, Jiangyan District, Taizhou, 225500, China
| | - Jijun You
- Orthopaedic Department, the Second People's Hospital of Taizhou Affiliated to Medical College of Yangzhou University, Taizhou, China
| | - Haibing Ding
- Orthopaedic Department, the Second People's Hospital of Taizhou Affiliated to Medical College of Yangzhou University, Taizhou, China
| | - Zhisheng Zhang
- Oncology Department, the Second People's Hospital of Taizhou affiliated to Medical College of Yangzhou University, No. 27, Jiangyan District, Taizhou, 225500, China
| | - Lin Cui
- Oncology Department, the Second People's Hospital of Taizhou affiliated to Medical College of Yangzhou University, No. 27, Jiangyan District, Taizhou, 225500, China
| | - Xiaomei Shen
- Oncology Department, the Second People's Hospital of Taizhou affiliated to Medical College of Yangzhou University, No. 27, Jiangyan District, Taizhou, 225500, China
| | - Xiaoxia Bian
- Oncology Department, the Second People's Hospital of Taizhou affiliated to Medical College of Yangzhou University, No. 27, Jiangyan District, Taizhou, 225500, China
| | - Yanqing Liu
- Institute of Medicine, Yangzhou University, No. 88, South Daxue Road, Yangzhou, 225001, China
| | - Jue Chen
- Oncology Department, the Second People's Hospital of Taizhou affiliated to Medical College of Yangzhou University, No. 27, Jiangyan District, Taizhou, 225500, China. .,Institute of Medicine, Yangzhou University, No. 88, South Daxue Road, Yangzhou, 225001, China. .,Respiratory Department, the Second People's Hospital of Taizhou Affiliated to Medical College of Yangzhou University, Taizhou, China.
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18
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Tong YH, Ding HY, Xin WX, Zhong LK, Xu GQ, Zhang B, Yang GN, Fang L. Cost-effectiveness analysis of durvalumab plus etoposide: platinum in the first-line therapy of extensive stage small-cell lung cancer from the Chinese payers' perspective. TUMORI JOURNAL 2021; 108:33-39. [PMID: 33511911 DOI: 10.1177/0300891620985309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Results from the CASPIAN trial (Durvalumab ± Tremelimumab in Combination With Platinum Based Chemotherapy in Untreated Extensive-Stage Small Cell Lung Cancer) trial demonstrated the clinical benefit of durvalumab plus etoposide-platinum (EP) chemotherapy as first-line treatment for patients with extensive stage small-cell lung cancer (ES-SCLC). However, considering the high price of durvalumab, it is unclear whether addition of durvalumab to EP chemotherapy has economic value compared with EP alone. In this study, we aimed to evaluate the cost-effectiveness of durvalumab plus EP chemotherapy as a first-line treatment for patients with ES-SCLC. METHODS A Markov model comprising three health states (stable, progressive, and dead) was developed to simulate the process of small-cell lung cancer. Utility and costs were obtained from published resources. Health outcomes were derived from the CASPIAN trial. Costs were calculated based on the standard medical fees in Zhejiang Province from Chinese patients' perspective. Utility values were obtained from published data. One-way and probabilistic sensitivity analyses were applied to verify model robustness. RESULTS The addition of durvalumab to EP chemotherapy costs more than $32,220, with a gain of 0.14 quality-adjusted life years (QALYs) compared with EP alone. The incremental cost-effective ratio was $230,142.9 per QALY, which exceeds the willingness to pay threshold of $28,527 per QALY. In the sensitivity analysis, the utility values for the progressive state, costs of durvalumab and EP chemotherapy, and costs for the progressive state were considered to be the three most sensitive factors in the model. CONCLUSION The addition of durvalumab to EP chemotherapy is not a cost-effective strategy in the first-line therapy of ES-SCLC from the Chinese payers' perspective.
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Affiliation(s)
- Ying-Hui Tong
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Hai-Ying Ding
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Wen-Xiu Xin
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Li-Ke Zhong
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Gao-Qi Xu
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Bo Zhang
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.,Department of Integrated Chinese and Western Medicine, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
| | - Guo-Nong Yang
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Luo Fang
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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Cost-Effectiveness of the Addition of Bevacizumab to First-Line Chemotherapy With Carboplatin and Paclitaxel in Patients With Non-Small Cell Lung Cancer. Value Health Reg Issues 2020; 23:93-98. [PMID: 33171359 DOI: 10.1016/j.vhri.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 04/09/2020] [Accepted: 04/19/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the incremental cost-effectiveness ratio (ICER) of the addition of bevacizumab to first-line chemotherapy with carboplatin and paclitaxel in patients with non-small cell lung cancer (NSCLC) from the perspective of the Colombian health system. METHODS A Markov model was employed to evaluate the cost-effectiveness of bevacizumab + carboplatin + paclitaxel (BCP) compared with carboplatin + paclitaxel (CP) in the treatment of NSCLS during a 4-year period. The health outcome was the number of life-years gained (LYG) and quality-adjusted life-years (QALYs) obtained from the survival curves reported in a clinical study. Costs were estimated using national tariff and reported in US dollars at a date in 2019. Costs and effectiveness outcomes were discounted at a rate of 3.5% per year. A probabilistic sensitivity analysis was performed on important parameters with a Monte Carlo simulation. RESULTS The costs of BCP and CP were $30 341 and $11 735, respectively. The LYG for BCP and CP were 0.34 and 0.29, respectively. The QALY for BCP and CP were 0.27 and 0.23. The ICER of BCP versus CP was $ 465 150 QALY. The results of the Monte Carlo simulation showed that CP was cost-effective in 100% of the iterations compared with BCP. CONCLUSION The addition of bevacizumab to the scheme carboplatin + paclitaxel compared to carboplatin + paclitaxel for NSCLC is not cost-effective from the point of view of the Colombian health system.
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Nowak AK, Brosseau S, Cook A, Zalcman G. Antiangiogeneic Strategies in Mesothelioma. Front Oncol 2020; 10:126. [PMID: 32133285 PMCID: PMC7040194 DOI: 10.3389/fonc.2020.00126] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/23/2020] [Indexed: 12/21/2022] Open
Abstract
There is a strong rationale for inhibiting angiogenesis in mesothelioma. Vascular endothelial growth factor (VEGF) is an autocrine growth factor in mesothelioma and a potent mitogen for mesothelial cells. Further, the abnormal tumor vasculature promotes raised interstitial pressure and hypoxia, which may be detrimental to both penetration and efficacy of anticancer agents. Antiangiogenic agents have been trialed in mesothelioma for close to two decades, with early phase clinical trials testing vascular targeting agents, the VEGF-A targeting monoclonal antibody bevacizumab, and numerous tyrosine kinase inhibitors, many with multiple targets. None of these have shown efficacy which has warranted further development as single agents in any line of therapy. Whilst a randomized phase II trial combining the multitargeted tyrosine kinase inhibitor nintedanib with platinum/pemetrexed chemotherapy was positive, these results were not confirmed in a subsequent phase III study. The combination of cisplatin and pemetrexed with bevacizumab, in appropriately selected patients, remains the only anti-angiogenic combination showing efficacy in mesothelioma. Extensive efforts to identify biomarkers of response have not yet been successful.
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Affiliation(s)
- Anna K Nowak
- National Centre for Asbestos Related Diseases, University of Western Australia, Crawley, WA, Australia.,Medical School, University of Western Australia, Crawley, WA, Australia.,Institute for Respiratory Health, University of Western Australia, Crawley, WA, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Solenn Brosseau
- Thoracic Oncology Department & CIC1425-CLIP2 Early Phase Cancer Clinical Trials Unit, University Hospital Bichat-Claude Bernard, Medical Faculty, University Paris-Diderot, Paris, France.,U830 INSERM "Cancer Heterogeneity, Plasticity", Institute Curie Research Centre, Paris, France
| | - Alistair Cook
- National Centre for Asbestos Related Diseases, University of Western Australia, Crawley, WA, Australia.,Medical School, University of Western Australia, Crawley, WA, Australia.,Institute for Respiratory Health, University of Western Australia, Crawley, WA, Australia
| | - Gérard Zalcman
- Thoracic Oncology Department & CIC1425-CLIP2 Early Phase Cancer Clinical Trials Unit, University Hospital Bichat-Claude Bernard, Medical Faculty, University Paris-Diderot, Paris, France.,U830 INSERM "Cancer Heterogeneity, Plasticity", Institute Curie Research Centre, Paris, France
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21
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Wan N, Zhang TT, Hua SH, Lu ZL, Ji B, Li LX, Lu LQ, Huang WJ, Jiang J, Li J. Cost-effectiveness analysis of pembrolizumab plus chemotherapy with PD-L1 test for the first-line treatment of NSCLC. Cancer Med 2020; 9:1683-1693. [PMID: 31945265 PMCID: PMC7050096 DOI: 10.1002/cam4.2793] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/15/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022] Open
Abstract
Background Pembrolizumab (Pembro) in combination with chemotherapy has been approved for the treatment of pretreated advanced NSCLC in the United States and China for its significant efficacy. However, the cost‐effectiveness is unknown considering Pembro's high price. The impact of programmed death ligand 1 (PD‐L1) test on the cost‐effectiveness is also unknown. The current study assessed the cost‐effectiveness of combination therapy for nonsquamous NSCLC from the United States and China public payers’ perspective. Materials and Methods A literature‐based Markov model was conducted using KEYNOTE‐189 trial data to compare cost and quality‐adjusted life years (QALYs) of three treatment strategies for nonsquamous NSCLC: Pembro‐chemotherapy combination and chemotherapy strategy without PD‐L1 test, and treatment strategy according to their PD‐L1 status. Results In base case analysis, the combination strategy generated an additional 0.78 QALYs and 0.59 QALYs over chemotherapy in the United States and China respectively, resulting in an ICER of $132 392/QALY in the United States and $92 533/QALY in China. In the PD‐L1 ≥1% base case, the ICERs were $77 754/QALY and $56 768/QALY respectively in the United States and China for PD‐L1 test strategy. In the PD‐L1 ≥50% base case, the ICERs were $44 731/QALY and $34 388/QALY respectively in the United States and China for PD‐L1 test strategy. Lowering Pembro price can also partly decrease the ICERs. Conclusion Compared with chemotherapy, the combination strategy is not cost‐effective for the treatment of NSCLC in the American and Chinese health care system at WTP threshold of $100 000/QALY for the United States and $27 351/QALY for China. Using PD‐L1 test for patient selection and price reduction could improve the cost‐effective probabilities of immunotherapy for nonsquamous NSCLC.
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Affiliation(s)
- Ning Wan
- Department of Pharmacy, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China.,Guangzhou Huabo Biopharmaceutical Research Institute, Guangzhou, Guangdong, China
| | - Tian-Tian Zhang
- College of Pharmacy, Jinan University, Guangzhou, Guangdong, China.,The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), Jinan University, Guangzhou, Guangdong, China
| | - Si-Hua Hua
- College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Zi-Luo Lu
- College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Bo Ji
- Department of Pharmacy, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Li-Xia Li
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Li-Qing Lu
- Department of Pharmacy, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Wen-Jie Huang
- Department of Respiratory Medicine, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
| | - Jie Jiang
- College of Pharmacy, Jinan University, Guangzhou, Guangdong, China.,The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.,International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Chinese Ministry of Education (MOE), Jinan University, Guangzhou, Guangdong, China.,Dongguan Institute of Jinan University, Dongguan, China
| | - Jian Li
- Department of Pharmacy, General Hospital of Southern Theater Command, Guangzhou, Guangdong, China
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Yang Y, Wu B, Huang L, Shi M, Liu Y, Zhao Y, Wang L, Lu S, Chen G, Li B, Xie C, Fang J, Yang N, Zhang Y, Cui J, Song Y, Zhang C, Mei X, Cao B, Yang L, Cheng Y, Ying K, Sun T, Ren B, Yu Q, Liao Z, Pei Z, Wang M, Zhou J, Yu S, Feng G, Wan H, Wang H, Gao S, Wang J, An G, Geng Y, Ji Y, Yuan Y, Ma S, Jia Z, Hu M, Zhou H, Yu J, Sun X, Zhang L. Biosimilar candidate IBI305 plus paclitaxel/carboplatin for the treatment of non-squamous non-small cell lung cancer. Transl Lung Cancer Res 2019; 8:989-999. [PMID: 32010577 PMCID: PMC6976344 DOI: 10.21037/tlcr.2019.12.23] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bevacizumab is a monoclonal antibody (mAb) against vascular endothelial growth factor (VEGF) and used for treatments of various cancers. Due to the high costs of bevacizumab treatments, a biosimilar provides an affordable alternative therapy for cancer patients. METHODS In this randomized, double-blind, multicenter, phase 3 study, locally advanced, metastatic or recurrent non-squamous non-small cell lung cancer (NSCLC) patients with wild-type epidermal growth factor receptor were enrolled and randomized (1:1) into IBI305 or bevacizumab groups. Patients received 6 cycles of paclitaxel/carboplatin plus IBI305 or bevacizumab 15 mg/kg intravenously followed by IBI305 or bevacizumab 7.5 mg/kg maintenance until disease progression, unacceptable toxicity or death. The primary endpoint was confirmed objective response rate (ORR) by an independent radiological review committee (IRRC) and secondary endpoints included disease control rate (DCR), progression-free survival (PFS), duration of response (DOR), overall survival (OS) and safety. RESULTS A total of 450 NSCLC patients were enrolled (224 in IBI305 group and 226 in bevacizumab group). ORRs were 44.3% for IBI305 and 46.4% for bevacizumab, and the ORR ratio was 0.95 (90% CI: 0.803 to 1.135), within the predefined equivalence margin of 0.75 to 1.33. No significant difference in PFS (7.64 vs. 7.77 m, P=0.9987) was observed between the 2 groups. Serious adverse events (AEs) occurred in 33.5% (75/224) of patients in the IBI305 group and 37.6% (85/226) in the bevacizumab group. AEs ≥ grade 3 were similar in the IBI305 and bevacizumab groups [84.4% (189/224) vs. 89.8% (203/226), P=0.085]. CONCLUSIONS IBI305 is similar to bevacizumab in terms of efficacy and safety. TRIAL REGISTRATION Clinicaltrials.org Identifier: NCT02954172. Registered on 3 November 2016. Https://clinicaltrials.gov/.
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Affiliation(s)
- Yunpeng Yang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510000, China
| | - Bin Wu
- Department of Respiratory Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China
| | - Linian Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Bengbu Medical College, Bangbu 233000, China
| | - Meiqi Shi
- Department of Oncology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Yunpeng Liu
- Department of Oncology, The First Hospital of China Medical University, Shenyang 110001, China
| | - Yanqiu Zhao
- Department of Respiratory Medicine, Henan Cancer Hospital, Zhengzhou 450003, China
| | - Lijun Wang
- Department of Tumor radiotherapy, The Second Affiliated Hospital of Xingtai Medical College, Xingtai 054000, China
| | - Shun Lu
- Department of Oncology, Shanghai Chest Hospital, Shanghai 200030, China
| | - Gongyan Chen
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Baolan Li
- General Department, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Conghua Xie
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jian Fang
- Department of Oncology, Peking University Cancer Hospital, Beijing 100142, China
| | - Nong Yang
- Department of Pulmonary Gastroenterology, Hunan Cancer Hospital, Changsha 410006, China
| | - Yiping Zhang
- Department of Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Jiuwei Cui
- Department of Oncology, The First Hospital of Jilin University, Changchun 130000, China
| | - Yong Song
- Department of Respiratory Medicine, General Hospital of Eastern Theater Command, Nanjing 210002, China
| | - Cuiying Zhang
- Department of Oncology, Inner Mongolia People’s Hospital, Hohhot 010017, China
| | - Xiaodong Mei
- Department of Respiratory Medicine, An Hui Provincial Hospital, Hefei 230000, China
| | - Bangwei Cao
- Department of Oncology, Peking Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Lan Yang
- Department of Respiratory Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
| | - Ying Cheng
- Department of Oncology, Jilin Cancer Hospital, Changchun 130000, China
| | - Kejing Ying
- Department of Respiratory Medicine, Sir Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Tao Sun
- Department of Internal Medicine, Liaoning Cancer Hospital & Institute, Shenyang 110046, China
| | - Biyong Ren
- Department of Respiratory Medicine, Chongqing three Gorges Central Hospital, Chongqing 404000, China
| | - Qitao Yu
- Department of Oncology, The Cancer Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, China
| | - Zijun Liao
- Department of Internal Medicine, Shaanxi Provincial Tumor Hospital, Xi’an 710061, China
| | - Zhidong Pei
- Department of Oncology, Luoyang Central Hospital Affiliated To Zhengzhou University, Luoyang 471009, China
| | - Mengzhao Wang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing 100005, China
| | - Jianying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital Zhejiang University, Hangzhou 310003, China
| | - Shiying Yu
- Department of Oncology, Tongji Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Guosheng Feng
- Department of Chemotherapy, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530000, China
| | - Huiping Wan
- Department of Oncology, Jiangxi People’s Hospital, Nanchang 330000, China
| | - Huaqing Wang
- Department of Oncology, Tianjin People’s Hospital, Tianjin 300121, China
| | - Shegan Gao
- Department of Oncology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China
| | - Jinliang Wang
- Department of Oncology, General Hospital of PLA, Beijing 100853, China
| | - Guangyu An
- Department of Oncology, Beijing Chao-Yang Hospital, Beijing 100020, China
| | - Yi Geng
- Department of Oncology, Baoji Central Hospital, Baoji 721008, China
| | - Yanxia Ji
- Department of Oncology, Handan Central Hospital, Handan 056001, China
| | - Ying Yuan
- Department of Oncology, The Second Affiliated Hospital Zhejiang University, Hangzhou 310009, China
| | - Shenglin Ma
- Department of Oncology, Hangzhou First People’s Hospital, Hangzhou 310002, China
| | - Zhongyao Jia
- Department of Oncology, Linyi People’s Hospital, Linyi 276003, China
| | - Mu Hu
- Department of Chest Surgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Hui Zhou
- Innovent Biologics, Inc., Suzhou 215123, China
| | - Jie Yu
- Innovent Biologics, Inc., Suzhou 215123, China
| | - Xing Sun
- Innovent Biologics, Inc., Suzhou 215123, China
| | - Li Zhang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510000, China
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Cost-effectiveness of Osimertinib as a Second-line Treatment in Patients With EGFR-mutated Advanced Non–Small Cell Lung Cancer in China. Clin Ther 2019; 41:2308-2320.e11. [DOI: 10.1016/j.clinthera.2019.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/21/2022]
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