ABSTRACT
OBJECTIVES: The current study aimed to evaluate the cost-effectiveness of sintilimab versus docetaxel as second-line treatment for patients with advanced or metastatic squamous non-small-cell lung cancer (NSCLC) in China. METHODS: A partitioned survival model was established to track 3-week patients' transition and project the health and economic outputs in 15-year horizon of the two competing options among sintilimab and docetaxel. Clinical data were obtained from the ORIENT-3 trial, and cost and utility values were gathered from the local charges and published studies. Total costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were evaluated. Sensitivity analyses were conducted to assess the robustness of the model outcomes. RESULTS: Base-case results revealed that sintilimab yield marginal cost of $4,700.53 and additional 0.32 QALYs, resulting in an ICER of $14,615.31 per QALY gained, which is lower than the willingness-to-pay threshold of $38,224/QALY in China. One-way sensitivity analyses showed that the cost of best supportive care was the main driver of the ICER, and probabilistic sensitivity analyses demonstrated that the model outputs were robust. CONCLUSIONS: Sintilimab could be considered the cost-effective second-line strategy for patients with advanced or metastatic squamous NSCLC compared with docetaxel in China.
Subject(s)
Antibodies, Monoclonal, Humanized , Carcinoma, Non-Small-Cell Lung , Carcinoma, Squamous Cell , Lung Neoplasms , Humans , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Docetaxel , Cost-Benefit Analysis , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Cost-Effectiveness AnalysisABSTRACT
Objective: To explore the association of diabetic retinopathy (DR) and diabetic macular edema (DME) with renal function in patients with type 2 diabetes mellitus (T2DM). Design: A prospective cohort study. Methods: This single-centre study included patients with no DR, mild non-proliferative DR (NPDR), and no DME at baseline. DR and DME were assessed using 7-field fundus photography and swept-source OCT (SS-OCT). The baseline renal function assessed included the estimated glomerular filtration rate (eGFR) and microalbuminuria (MAU). Cox regression analyses were used to assess the hazard ratio (HR) of renal function with the progression of DR and the development of DME. Results: A total of 1409 patients with T2DM (1409 eyes) were included. During 3 years of follow-up,143 patients had DR progression, and 54 patients developed DME. Low eGFR levels at baseline were associated with the development of DR (HR, 1.044 per 1-SD decrease; 95% CI, 1.035-1.053; P < 0.001). Compared to the participants with eGFRs >90 mL/min/1.73 m2, the participants with eGFRs of 60-90 mL/min/1.73 m2 (HR, 1.649; 95% CI, 1.094-2.485; P = 0.017) or < 60 mL/min/1.73 m2 (HR, 2.106; 95% CI, 1.039-4.269; P = 0.039) had a higher risk of DR progression. Increasing MAU tertiles were associated with progression of DR (Tertile 2: HR, 2.577; 95% CI, 1.561-4.256; P < 0.001; Tertile 3: HR, 3.135; 95% CI, 1.892-5.194; P < 0.001). No significant relationship was found between renal function and the development of DME (P > 0.05). Conclusions: Abnormal renal profiles (i.e., low levels of eGFR and high levels of MAU) were associated with the progression of DR, but not with the development of DME.
