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OBJECTIVE To assess the long-term cost-effectiveness of five glucagon-like peptide-1 receptor agonists (GLP- 1RAs) in the treatment of poorly controlled type 2 diabetes mellitus (T2DM) treated with metformin. METHODS Baseline data from patients in previously published meta-analysis and included randomized controlled trials (RCTs) were extracted to predict survival, long-term efficacy, and costs for each group using the United Kingdom prospective diabetes study outcome model 2.1. The cost-effectiveness of 5 GLP-1RAs (liraglutide, lixisenatide, exenatide, dulaglutide, and semaglutide) was analyzed by cost- utility analysis. Sensitivity analysis and scenario analysis were also performed to verify the uncertainty of basic analysis results. RESULTS A total of 21 RCTs with 6 796 patients were included. Survival analysis curves showed the superiority of semaglutide in reducing the risk of death from cardiovascular disease and dulaglutide in reducing the risk of all-cause mortality over other GLP- 1RAs. The cost-utility analysis showed that the five drugs were economically superior to inferior in the order of lixisenatide, semaglutide, exenatide, dulaglutide, and liraglutide; one-way and probabilistic sensitivity analyses indicated that the results were robust. The scenario analysis results indicated that the price of semaglutide should decrease by at least 54.64% to 369.21 yuan, which is cost-effectiveness compared to lixisenatide. CONCLUSIONS For T2DM patients in China with poor glycemic control after treatment with metformin, lixisenatide and semaglutide may be considered as the preferred regimen.
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OBJECTIVE To evaluate the cost-effectiveness of tislelizumab combined with chemotherapy as first-line treatment for locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma. METHODS The data of RATIONALE-305 study and related literature were used to establish a partitioned survival model from the perspective of China’s health system. The cycle was 3 weeks, the simulation time was set as 10 years, and the discount rate was 5%. The quality-adjusted life years (QALYs) were used as the health outcome indicator to evaluate the cost-effectiveness of tislelizumab combined with chemotherapy versus placebo combined with chemotherapy as first-line treatment for locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma, and one-way sensitivity analysis and probabilistic sensitivity analysis were also conducted. RESULTS The base analysis showed that the patients received more 0.268 QALYs with tislelizumab plus chemotherapy, compared with placebo plus chemotherapy, but the cost increased by 70 404.81 yuan with an incremental cost- effectiveness ratio (ICER) of 262 431.62 yuan/QALY, which was less than three times China’s gross domestic product (GDP) per capita in 2023 as the willingness-to-pay (WTP) threshold (268 074 yuan/QALY). One-way sensitivity analysis showed that the efficacy value of progress free survive and the price of tislelizumab had a greater impact on the ICER value. The results of probability sensitivity analysis showed that when the WTP threshold was 3 times China’s GDP per capita in 2023, the probability of tislelizumab being cost-effective was 53.3%. CONCLUSIONS When the WTP threshold is 3 times China’s GDP per capita in 2023, tislelizumab plus chemotherapy is cost-effective for first-line treatment of locally advanced unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma, compared with placebo plus chemotherapy.
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OBJECTIVE To evaluate the economics of serplulimab combined with chemotherapy regimens for the first-line treatment of extensive-stage small cell lung cancer (ES-SCLC) from the perspective of health system in China. METHODS A partitioned survival model was constructed based on the ASTRUM-005 clinical trial and related literature data, with a model simulation time frame of 10 years and a 3-week cycle, and both cost and utility values were discounted using a 5% discount rate. The quality-adjusted life year (QALY) was used as a model output indicator and the incremental cost-effectiveness ratio (ICER) was calculated to evaluate the economics of serplulimab combined with chemotherapy regimens (serplulimab group) versus chemotherapy alone regimens (chemotherapy alone group) for the first-line treatment of ES-SCLC. One-way sensitivity analysis and probabilistic sensitivity analysis were used to verify the robustness of the results of the base-case analysis and to conduct a scenario analysis for the serplulimab patient assistance program. RESULTS The results of the base-case analysis showed that compared with chemotherapy alone group, ICER of serplulimab group was 758 690.27 yuan/QALY, which was higher than 3 times China’s per capita gross domestic product (GDP) in 2022 as the willingness-to-pay (WTP) threshold. The results of the scenario analysis showed that compared with chemotherapy alone group, the ICER of serplulimab group was 172 275.74 yuan/QALY, which was below above WTP threshold. The one-way sensitivity analysis showed that the progress-free survival utility value, serplulimab price and so on had a significant impact on the model results. The results of the probabilistic sensitivity analysis showed that the probability of the serplulimab group being economic was 0 when the serplulimab patient assistance program was not considered, but 100% when the patient assistance program was considered. CONCLUSIONS At a WTP threshold of 3 times China’s per capita GDP in 2022, the serplulimab group is no cost-effectiveness compared to the chemotherapy alone group; however, this result is reversed when the patient assistance program is taken into account.
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OBJECTIVE To evaluate the cost-effectiveness of denosumab and zoledronic acid in the treatment of postmenopausal osteoporosis ,and to provide reference for relevant decision-making. METHODS From the perspective of Chinese health system ,Excel 2003 software was used to establish Markov model ,and cost-utility analysis was used to evaluate the cost-effectiveness of denosumab or zoledronic acid combined with calcium carbonate D 3 in the treatment of postmenopausal osteoporosis. Pharmacotherapy effects were obtained from the network Meta-analysis ,and cost and health-utility value data were obtained from the published literature or network ,etc. The model cycle was 1 year,and the simulation time limit was the patient ’s lifetime. One-way sensitivity analysis and probabilistic sensitivity analysis were used to evaluate the impact of model parameter changes on the robustness of the results ;and the cost-effectiveness of changing the medication cycle of zoledronic acid were explored through scenario analysis. RESULTS Denosumab regimen was more effective than zoledronic acid regimen (12.77 QALYs vs. 11.98 QALYs),and its cost was also higher than zoledronic acid regimen (51 224.56 yuan vs. 49 221.67 yuan), and the incremental cost-effectiveness ratio was 2 544.14 yuan/QALY. One-way sensitivity analysis showed that the cost of Zoledronic acid injection and that of Denosumab injection had great impact on the results. The results of probabilistic sensitivity analysis showed that when using 3 times of per capita gross domestic product (GDP)in China in 2021 as the threshold of willingness to pay ,the probability of Denosumab regimen being cost-effective was 85.4%. The results of the scenario analysis showed that the Denosumab regimen was still more cost-effective when the dosing cycle of zoledronic acid was changed. CONCLUSIONS Under the threshold of 1-3 times of Chinese per capita GDP in 2021,denosumab combined with calcium carbonate D 3 is more cost-effective than zoledronic acid combined with calcium carbonate D 3 in the treatment of postmenopausal osteoporosis.
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OBJECTIVE To evaluate the cost-effectiveness of durvalumab for consolidation therapy after chemoradiotherapy for unresectable stage Ⅲ non-small cell lung cancer from the perspective of the Chinese health care system. METHODS A Markov model was developed by using updated four-year survival data from the PACIFIC trial in May 2021 and relevant literature. The cost-effectiveness of durvalumab for consolidation therapy after chemoradiotherapy for unresectable stage Ⅲ non-small cell lung cancer was evaluated by using quality-adjusted life years (QALYs)as health output index with 20-year simulation time frame and a 2-week cycling period. The costs and health output were discounted using discount rate of 5%;one-way sensitivity analysis and probabilistic sensitivity analysis were used to examine the robustness of the model simulation results. RESULTS The results of the base analysis showed that compared with placebo group ,durvalumab resulted in 0.73 QALYs at an incremental cost of 1 076 062.86 yuan and an incremental cost-utility ratio (ICER)of 1 467 546.54 yuan/QALY,which was much higher than 3-fold per capita gross domestic products (GDP)in 2020(217 713 yuan)as willingness-to-pay (WTP)threshold. The results of one-way sensitivity analysis showed that the price of durvalumab and discount rate had a great impact on ICER. Probabilistic sensitivity analysis showed no cost-effective advantage for durvalumab when the WTP threshold was three times of GDP per capita in 2020 (217 713 yuan). CONCLUSIONS From the perspective of Chinese health care system ,there is no cost-effective advantage to the use of durvalumab for consolidation therapy after chemoradiotherapy for unresectable stage Ⅲ non-small cell lung cancer when the WTP threshold was three times of GDP per capita in 2020.
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OBJECTIVE To systematically evaluate the economical efficiency of marketed a naplastic lymphoma kinase (ALK)-tyrosine kinase inhibitors (TKI)for the treatment of ALK-positive non-small cell lung cancer (NSCLC)in China ,and to provide a reference for the selection of China ’s medical insurance list and drug pricing. METHODS Computer searches of databases such as CNKI ,Wanfang database ,VIP,PubMed,Embase and the Cochrane Library were conducted to collect pharmacoeconomic evaluation studies of four marketed ALK-TKI (crizotinib,seretinib,aletinib and ensatinib )in the treatment of ALK-positive NSCLC in China during the inception to July 2021. The qualities of the included literature were evaluated using CHEERS checklist ,and analyzed systematically in terms of both methodological and economic outcomes. RESULTS A total of 6 literatures were included ,with a compliance rate of 71% to 83% for the CHEERS list criteria ,and the overall quality of the literature was high. In terms of methodological analysis ,the pharmacoeconomic evaluation methods included in the study were mainly model-based (Markov or partitioned survival models ) and real-world data-based cost-utility analysis. Most research perspectives were health insurance payer and health system perspectives ;all cost types were direct medical costs. In terms of economical efficiency analysis ,compared with chemotherapy plan ,2 studies confirmed that ALK-TKI (crizotinib,seretinib)were not economic ,1 study confirmed ALK-TKI (crizotinib) showed economical efficiency. Seretinib showed relatively higher economical efficiency when compared to other ALK-TKIs. High drug prices were the main factor why ALK-TKI was not economically viable for treating ALK-positive NSCLC. CONCLUSIONS The second-generation ALK-TKI (seretinib, 163.com alectinib) have better economical efficiency than the first-generation ALK-TKI (crizotinib). The economical efficiency of seretinib is the best among the second-generation · ALK-TKI. The economical efficiency of chemotherapy regimen is better than that of the second-generation ALK-TKI (seretinib). Economic comparison between chemotherapy and first-generation ALK-TKI (crizotinib)remains controversial.
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OBJECTIVE To evaluate the cost-utility of pembrolizumab combined with chemotherapy versus chemotherapy alone in the first-line treatment of advanced or metastatic esophageal carcinoma. METHODS Cost-utility analysis of pembrolizumab combined with chemotherapy versus chemotherapy alone for advanced or metastatic esophageal carcinoma was conducted by using a three-state partitioned survival model from the perspective of health system in China. The model use d a lifetime simulation time frame with 3 weeks as a cycle. The survival data were extrapolated using KEYNOTE- 590 data;cost data were obtained from the median of 2022 public winning bid on Yaozhi network ,among which the price of pembrolizumab was obtained after discounting by a patient assistance program ;utility data were obtained from the literatures ,and a 5% discount rate was used for both cost and utility. One-way sensitivity analysis and probabilistic sensitivity analysis were also conducted to examine model robustness. RESULTS Analysis of the base case results showed that compared to chemotherapy alone ,the incremental cost-effectiveness ratio (ICER)of pembrolizumab combined with chemotherapy regimens were 950 528.42 yuan/QALY,107 845.39 yuan/QALY and 315 754.56 yuan/QALY for esophageal squamous cell carcinoma (ESCC),programmed deathligand- 1 combined positive score (PD-L1 CPS)≥10 and intention-to-treat population (ITT),respectively. The results of sensitivity analysis verified the robustness of the basic analysis results. CONCLUSIONS Under our healthcare system ,using a threshold of willingness-to-pay of 1-3 times our GDP per capita in 2021,pembrolizumab combined with chemotherapy regimen isn ’t cost-utility compared with chemotherapy alone in the ESCC and ITT subgroups of patients ,while it is cost-utility in the PD-L 1 CPS≥10 subgroup of patients.
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IL-37 is a member of the IL-1 family of cytokines, which functions as a natural suppressor of inflammatory and immune responses. IL-37 likely functions to limit excessive inflammation, accordingly, IL-37 levels are abnormal in patients with inflammatory and autoimmune diseases. In this review, we provide an overview of the anti-inflammatory mechanism of IL-37. It also summarizes the research progress of expression and its role in bronchial asthma, a heterogeneous chronic airway inflammatory disease.
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This study is aimed to make a comprehensive introduction to the anti-MRSA drugs,and also to compare the safety and efficacy among a variety of anti-MRSA drugs.Finally,it is pointed that we should select the anti-MRSA drugs precisely according to different situation of disease when treating the infection with MRSA.Then we can make the individualized treatment for patients and provide a basis for the disease when treatment of patients as well.