Pharmacoeconomic Evaluation Of Erlotinib For The Treatment Of Advanced Pancreatic Cancer

Objective: Pancreatic cancer has a high degree of malignancy and a poor prognosis.Erlotinib is the only targeted drug approved for first-line clinical treatment of advanced pancreatic cancer in China.However,the cost of targeted medicines is relatively high.From the perspective of China's medical and health,this topic combines the clinical application of erlotinib in China,performed cost-effectiveness analysis,and provided references for promoting the rational use of pancreatic cancer treatment and the formulation of national health-related policiesMethods: A dynamic Markov model and a static Markov model were used to simulate the disease progression of patients with advanced pancreatic cancer.The dynamic Markov model reads patient data from large international clinical trials,uses Weibull distribution to simulate survival curves,and calculates transition probability.The static Markov model uses the DAELE principle to perform integrated calculations on the survival time of patients reported in clinical studies that meet the criteria for inclusion in the literature,to obtain the transition probability that includes Chinese patient data.Based on the actual clinical situation in China and the cost-effectiveness data reported in related literature,a three-state dynamic Markov model and a four-state static Markov model are established for analysis.Carry out Roll Back?Cohort Simulation?Cost-effectiveness Analysis ? Monte Carlo Simulation and sensitivity analysis on the two models,respectively.Results: The dynamic Markov model showed that the first-line treatment of patients with advanced pancreatic cancer with erlotinib combined with gemcitabine in the experimental group cost 99,595.39 yuan and received 7.02 QALM,while the control group received 60,492.78 yuan with gemcitabine,and obtained 6.34 QALM.Compared with the control group,although the experimental group obtained more QALM,the cost also increased.The increment cost-effectiveness radio is 57503.84 yuan / QALM,which is higher than the willingness to pay in China(16161 yuan / QALM).When the WTP value increased to 56,000 yuan / QALM,the probability of erlotinib combined with gemcitabine chemotherapy has cost-effectiveness was more than 50%.The static Markov model shows that the experimental group spends 123740.19 yuan and obtains 9.13 QALM,compared with the control group which costs 79881.99 yuan to obtain 7.79 QALM,the cost and effectiveness increase,but the increment cost-effectiveness radio is 33270.00 yuan / QALM,which is also higher than China's willingness to pay value.When the WTP value increased to 35,000 yuan / QALM,the probability of chemotherapy regimen in the experimental group has cost-effectiveness was exceed 50%.Sensitivity analysis shows that the drug cost of the experimental group and PFS status utility value in the dynamic Markov model have a greater impact on the model;in the static Markov model,PGpd and PGEpd have a greater impact.However,the changes of the above parameters within the specified range do not affect the determination of the final results of the respective models,and the models are stable.Conclusion: From the perspective of Chinese health care and the current willingness to pay in China,both the dynamic Markov model and the static Markov judge that compared with gemcitabine,erlotinib combined with gemcitabine is not a cost-effectiveness treatment for the first-line treatment of advanced pancreatic cancer;As the WTP increases or the price of chemotherapeutic drugs decreases,the probability that erlotinib combined with gemcitabine in the first-line treatment of advanced pancreatic cancer has economic significance has gradually increased.