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尽管一项多中心临床III期试验表明在晚期非小细胞肺癌维持治疗中厄洛替尼联用贝伐珠单抗对比贝伐珠单抗单用可增加无进展生存期,但联用方案长期使用的经济性未知,而本研究目的是评价上述两种治疗方案何者最佳。本研究以临床三期试验ATLAS为对象,通过马尔科夫模型模拟10年,以增量成本-效用为产出,估算两种治疗方案的合理性。结果表明,联用方案为最佳方案,增量成本-效用为$70 962.53/QALY,该值明显高于我国3倍人均GDP,说明联用方案不具有成本-效用性。一元敏感度分析表明,改变各因素对结果无影响,而概率敏感度分析表明,成本及效用概率敏感度分布呈正太分布,说明结果的稳定性。结果显示,贝伐珠单抗单用方案为最佳治疗方案。
Although a multicenter, phase III clinical trial of erlotinib versus bevacizumab in combination with bevacizumab alone may increase progression-free survival in advanced non-small cell lung cancer maintenance therapy, long-term use of the regimen The economics of use are unknown, and the purpose of this study was to evaluate which of the two treatment options is the best. In this study, the three-phase clinical trial of ATLAS was carried out. The Markov model was used to simulate 10 years and the incremental cost-utility was used as output to estimate the rationality of the two treatment plans. The results show that the combination scheme is the best one, and the incremental cost-utility is $ 70 962.53 / QALY, which is obviously higher than China’s 3x GDP per capita, indicating that the combination scheme is not cost-effective. The univariate sensitivity analysis shows that changing the factors has no effect on the results, while the probabilistic sensitivity analysis shows that the sensitivity distribution of costs and utility probabilities is positively distributed, indicating the stability of the results. The results showed that bevacizumab single-use regimen as the best treatment.