HER-2陽性晚期胃癌多種序貫治療方案的成本-效用分析

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中圖分類號R956；R735.2 文獻(xiàn)標(biāo)志碼A 文章編號 1001-0408（2025）13-1629-06

DOI 10.6039/j.issn.1001-0408.2025.13.13

Cost-utility analysis of multiple sequential treatment regimens for HER-2 positive advanced gastric cancer LIUNana，GUAN Xin，HU Xia（School of InternationalPharmaceutical Business，China Pharmaceutical University，Nanjing ，China）

ABSTRACTOBJECTIVEToevaluate thecost-effectivenessof diferentsequential treatmentregimens forhumanepidermal growth factorreceptor2（HER-2）-positiveadvancedgastriccancer fromtheperspectiveof the Chinese health system.METHODS Survival data wereobtained from the ToGA，WJOG4007 andRAINBOW-Asia trials，andadjustedusing network meta-analysis.A four-stateMarkovmodelwasconstructedtoevaluatethecost-effctivenessofsixtreatmentsequences，withalifetimesimulation horizonandacycleperiodof4weeks（28d），andthemainoutput parametersofthe modelincludedtotalcosts，quality-adjusted life year（QALY），andincrementalcost-ectivenessatio（CER）Sensitivityanalysis wasconductedtotesttheobustnsofte basicanalysisresults，andapricereductionscenario analysis fortrastuzumab wasperformed.RESULTs Comparedwith chemotherapysequentiallytreatedwithpalitaxel，theICERof trastuzumabcombinedwithcemotherapysequentiallytreatedwith paclitaxel，oririnotecan，orramucirumabpluspaclitaxelwere349845.25，772410.64，and2510470.39yuan/QALY， respectively，allexceeding threetimes China’s2023percapitagrossdomesticproduct（GDP）（268074yuan/QALY）as the willingness-o-ay（W）threshold.TisindicatedtatchemotherapysequentialpaclitaxelwasteotialtreatmentregienThe sensitivityanalysisconfirmedtherobustnessofthebasicanalysis.Thescenarioaalysisshowedthatwhentrastuzumabwasreduced by more than 20% ，trastuzumab combined with chemotherapy sequentially treated with paclitaxel became cost-effctive under this study’sWTP threshold.CONCLUSIONSWhenusing three times China’s 2023percapitaGDPasthe WTPthreshold， chemotherapysequentiallytreatedwithpaclitaxelistheoptimalregimenforHER-2positiveadvancedgastriccancer，with trastuzumabcombinedwithchemotherapysequentiallytreatedwithpaclitaxelasthesecondbestoption.Withenhancedmedical insuranceoptimization，trastuzumabcombinedwithchemotherapysequentialltreatedwithpaclitaxelisexpectedtobecomethe most cost-effective treatment regimen.

KEYWORDsHER-2positive advanced gastriccancer;chemotherapy；paclitaxel；trastuzumab；sequential therapy；cost-utility analysis；network meta-analysis；Markov model

胃癌是指原發(fā)于胃的上皮源性惡性腫瘤。（剩余12662字）