Optimization of cost-utility analysis with equal value of life-year gained:a case study of RAS-mutant metastatic colorectal cancer
OBJECTIVE To provide a reference for the improvement of pharmacoeconomic evaluation and health economic decision-making in China.METHODS From the perspective of China's healthcare system,a three-state partitioned survival model was constructed based on the BECOME study,the quality-adjusted life year(QALY)and equal value of life-year gained(evLYG)were used as the health gain measures respectively,and the cost-utility analysis was used to evaluate the cost-effectiveness of bevacizumab combined with chemotherapy regimen versus chemotherapy alone in the first-line treatment of RAS-mutant metastatic colorectal cancer(mCRC).The cycle length was 2 weeks,the time horizon was the patients'lifetime,the discount rate was 5％,and the willingness-to-pay threshold was 1 to 3 times China's gross domestic product per capita in 2023(89 358-268 074 yuan).One-way sensitivity analysis and probabilistic sensitivity analysis were used to assess the robustness of the results.RESULTS Compared to the chemotherapy alone,the incremental cost-effectiveness ratio(ICER)of the bevacizumab combined with chemotherapy regimen was calculated to be 330 311.33 yuan/QALY based on QALY,which exceeded the willingness-to-pay threshold(268 074 yuan).However,when the ICER was calculated based on evLYG,it was determined to be 254 085.64 yuan/evLYG,which fell below the willingness-to-pay threshold(268 074 yuan).The results of the one-way sensitivity analysis showed that the price of bevacizumab had the greatest impact on the ICER value.The results of the probabilistic sensitivity analysis showed that the probability of the bevacizumab combined with chemotherapy regimen being more cost-effective was approximately 3％when assessed by QALY;the probability of the regimen being more cost-effective rose to 56％when assessed by evLYG.CONCLUSIONS When evaluating the cost-effectiveness of interventions for RAS-mutant mCRC,ICER values based on evLYG may provide a fairer measure compared to ICER values calculated by QALY.It is recommended that when pharmacoeconomic evaluations are conducted for special populations,both QALY and evLYG can be used as health outcome indexes for evaluation to achieve a better allocation of healthcare resources and improve the fairness of decision-making.
equal value of life-year gainedquality-adjusted life yearRAS-mutant metastatic colorectal cancerpharmacoeconomics
万方数据
维普
