ABSTRACT
OBJECTIVE To evaluate the econo mical efficiency of ensatinib i n the first-line treatment of anaplastic lymphoma kinase（ALK）positive-advanced non-small cell lung cancer （NSCLC），so as to provide reference for China ’s medical insurance decision-making and rational drug use in clinic. METHODS A three-state partitioned survival model was constructed from the perspective of China ’s health system ，based on the data of the international multi-center phase Ⅲ clinical trial （eXalt3 trail），with simulation time limit of 10 years，cycle period of 30 days. The economical efficiency of ensatinib was compared with that of crizotinib（standard treatment ）in the first-line treatment of ALK positive-advanced NSCLC. The incremental cost-effectiveness ratio （ICER） was calculated with quality-adjusted life years （QALYs） as utility index. The stability of basic analysis results was validated through uncertainty analysis. RESULTS The basic analysis results showed that compared with crizotinib group ， incremental cost per capita of ensatinib group was －343 370.36 yuan，incremental utility per capita was 0.76 QALYs，ICER was －454 292.25 yuan/QALY，which was far lower than the willingness-to-pay （WTP）threshold of 1 time of China ’s per capita gross domestic product （GDP，80 976 yuan）in 2021. The results of univariate sensitivity analysis showed that progression-free survival （PFS）status utility ，progression of disease （PD）status utility and subsequent treatment cost of crizotinib had a greater impact on ICER，but these parameters could not cause the reversal of basic analysis results. Probabilistic sensitivity analysis showed that with 1 time of China ’s per capita GDP in 2021 as the WTP threshold ，the probability of ensatinib group ’s treatment possessed economical efficiency was 100％. In the situational analysis ，ICER obtained by changing the ensatinib group ’s follow-up treatment regimen was －217 671.43 yuan/QALY，which was far below WTP threshold. CONCLUSIONS For Chinese patients with ALK positive-advanced NSCLC ，compared with commonly used the first-line treatment （crizotinib），ensartinib is economical and absolutely dominant.
ABSTRACT
OBJECTIVE：To evaluate the co st-utility of bivalent human papilloma virus （HPV）vaccine for 12-year-old girls in China and provide economic evidence for health service decision makers. METHODS ：The CERVIVAC model was used to simulate the population of 12-year-old girls in China for a long time until all the population entered a state of death （1 year as a cycle ）. The cost and health output of the people in experimental group who received the bivalent HPV vaccine and the control group who did not receive the vaccine were calculated separately ， and the economics was judged combined with willingness to pay threshold [WTP ，1 time of China ’s per capita gross domestic product （GDP）in 2019]. RESULTS ：During the simulation period ， the incremental cost-effectiveness ratio （ICER） of the experimental group compared with the control group was 28 660.56 yuan/QALY，which was less than WTP and had pharmacoeconomic advantages. The results of single-factor sensitivity analysis showed that the five parameters that had a greater impact on ICER were discount rate ，the proportion of HPV- 16/HPV-18-induced cervical cancer ，vaccine effective rate ，direct economic burden of early/in situ cancer each year and the direct economic burden of advanced/metastatic cancer each year. The results of probabilistic sensitivity analysis showed that the experimental group was more acceptable（74％）than the control group when using 1 time of China ’s per capita GDP in 2019 as WTP ；the experimental group had a greater cost-utility advantage when WTP was higher than 25 876 yuan/QALY. CONCLUSIONS ：For the prevention of cervical cancer，the bivalent HPV vaccine for 12-year-old girls in China has more cost-utility advantages than no vaccine intervention.