Multi-criteria decision analysis of four first-line combination immunotherapy for unresectable hepatocellular carcinoma
OBJECTIVE To evaluate the comprehensive value of four first-line combination immunotherapy for unresectable hepatocellular carcinoma,and provide a reference for determining the optimal clinical treatment decision for unresectable hepatocellular carcinoma.METHODS R4.2 software was used for network meta-analysis to obtain the effect values of the efficacy and safety indicators of four combination therapies[atezolizumab combined with bevacizumab(AB),sintilimab combined with bevacizumab biosimilars(SB),camrelizumab combined with apatinib(CA),durvalumab combined with tremelimumab(DT)].Combined with the efficacy,safety and economic indicators,the categorical based evaluation technique(M-MACBETH)was used to establish the value tree.At the same time,the comprehensive value scores of four therapies were calculated,and sensitivity analysis was performed to evaluate the robustness.RESULTS In terms of prolonging median overall survival,the advantage order of the four therapies was ranked as SB,CA,AB and DT.In terms of extending median progression-free survival,the advantage order of the four therapies was CA,SB,AB and DT.In terms of safety,the order of advantages was DT,AB,SB and CA.In terms of economy,the order of advantages was CA,SB,AB and DT.The comprehensive scores of SB,CA,AB and DT were 67.11,57.77,52.53 and 42.59 points,respectively.The results of the sensitivity analysis showed that the ranking results of comprehensive value for four regimens were robust.CONCLUSIONS Among the four first-line immune combination therapies for unresectable hepatocellular carcinoma,SB is the optimal treatment regimen,followed by CA,AB and DT.
万方数据
维普
