ABSTRACT
OBJECTIVE To evaluate the cost-effectiveness of pembrolizumab combined with chemotherapy versus placebo combined with chemotherapy in the first-line treatment of advanced or unresectable biliary tract carcinoma （BTC） from the perspective of China’s health system. METHODS A partitioned survival model was constructed based on the KEYNOTE-966 study data. The simulation period was 21 days， and the simulation time was the patient’s whole life. Using quality-adjusted life year （QALY） as the output indicator， the cost-utility analysis method was used to evaluate the cost-effectiveness of the two schemes mentioned above. Univariate and probabilistic sensitivity analyses were performed to verify the results of the basic analysis， and to explore the cost-effectiveness under the scenario of drug donation scheme. RESULTS The basic analysis showed that both the cost and effectiveness of the pembrolizumab group were higher than those of the placebo group， and the incremental cost-effectiveness ratio （ICER） was 3 909 359.78 yuan/QALY， which was higher than the willingness-to-pay （WTP） threshold of 3 times 2022 gross domestic product （GDP） per capita （257 094 yuan）， indicating no cost-effectiveness. The results of univariate sensitivity analysis showed that the utility discount rate， the utility value of progression-free survival （PFS） status， the cost discount rate， and the cost of pembrolizumab had a great influence on ICER. Probabilistic sensitivity analysis verified the robustness of the results of basic analysis， and concluded that when the WTP threshold was greater than 1 500 000 yuan/QALY， the pembrolizumab group became cost-effective. The results of the scenario analysis showed that considering the drug donation scheme of pembrolizumab for low-income people， although its treatment cost was significantly reduced， it was still not cost-effective. CONCLUSIONS At the WTP threshold of 3 times China’s GDP per capita in 2022， pembrolizumab combined with chemotherapy is not cost-effective compared with placebo combined with chemotherapy for advanced or unresectable BTC.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the protective effect of Injection of Panax quinquefolium diolsaponins (IPQDS) and its mechanism on acute myocardial infarction in rats.</p><p><b>METHOD</b>The acute myocardial infarct model was prepared by left anterior descending coronary occulusion for 24 hours in open chest anesthetized rats. The myocardial infarct size (MIS) was calculated. The activities of serum creatine hosphokinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and the contents of malondialdehyde (MDA) and nitric oxide (NO) were determined. Blood was collected to observe low shearing specific viscosity, middle shearing specific viscosity and high shearing specific viscosity of whole blood and plasma viscosity. At the same time, the platelet aggregation rate and platelet adherence rate were also determined.</p><p><b>RESULT</b>In rats treated by IPQDS (in a dosage of 12.5, 25 and 50 mg x kg(-1) d, i.p. 3d ), the MIS was significantly reduced. The activities of serum CK, LDH and AST, and the content of serum MDA were declined. The activities of SOD and GSH-Px, and the content of NO were increased markedly. In addition, low shearing specific viscosity, middle shearing specific viscosity and high shearing specific viscosity of whole blood and plasma viscosity as well as platelet aggregation rate were also declined significantly. But platelet adherence rate had no significant change.</p><p><b>CONCLUSION</b>IPQDS has a protective effect on acute myocardial ischemia, which may be related to increasing activity of antioxidase in body, scavenging the damage of peroxidation from oxygen free radicals, decreasing the viscosity of blood and plasma and preventting thrombosis etc.</p>