免疫抑制劑在轉移性泌尿上皮癌的成本效果分析

單一中心回顧性研究

楊立宇、李建儀、裘坤元

台中榮民總醫院 泌尿部

Cost-Effectiveness Analysis of Immune Checkpoint Inhibitors in Metastatic Urothelial Cancer, A Single-Center Retrospective Study

Li-Yu Yang, Jian-Ri Li, Kun-Yuan Chiu

Department of Urology, Taichung Veterans General Hospital, Taiwan

Purpose: Immune checkpoint inhibitors (ICIs) are important treatment in metastatic urothelial carcinoma (mUC), however, the cost effectiveness benefits are unclear in Taiwan. This study estimated the payment benefits among patients diagnosed with metastatic urothelial cancer.

Materials and Methods: We retrospectively analyzed mUC patients between January 2016 and December 2020. Of these patients had received chemotherapy and ICIs (Pembrolizumab, Atezolizumab, Nivolumab, Durvalumab, Avelumab). Patients were followed from mUC diagnosis to death or last follow-up to estimate lifetime costs and cost per life day.

Results: Of the 80 included patients, the median age was 66 years and 65% were male. Among them, 17 patients received chemotherapy alone, and other 63 patients received chemotherapy followed by ICIs (45 patients received atezolizumab, 12 received pembrolizumab, and 3 received Nivolumab, Durvalumab, Avelumab separately). Fifty-nine (73.75%, 59/80) received cisplatin among all patients. Median overall survival was 27.93 months (95% CI, 12.5 months to not reached) in ICI group and 4.97 months (95% CI, 1.2 months to 7.43) in chemotherapy alone. ICI group had higher lifetime cost than chemotherapy alone (1209969.0 TWD, [IQR 762631.0 to 2017630.0] v 625850.0 TWD, [IQR 213669.0 to 719964.8], p<0.0001). Hospitalizations were the primary cost drivers of lifetime costs, comprising about 72% of all costs, followed by outpatient costs (26%). There was no statistically significant difference in the cost per life day between ICIs combined group and chemotherapy alone (3306.1 TWD per day, [IQR 1995.5 to 5442.9] v 2916.4, TWD per day, [IQR 1452.5 to 5010.8], p=0.7642). Favorable response group to ICIs had similar cost per life day compared with chemotherapy alone. (2925.7 TWD per day, [IQR 1689.11 to 5401.0] v 2916.4, TWD per day, [IQR 1452.5 to 5010.8], p= 0.9036). Even poor response to ICIs, there was no statistically significant difference in cost per life day compared with chemotherapy alone. (3600.7 TWD per day, [IQR 2206.8 to 5717.4] v 2916.4, TWD per day, [IQR 1452.5 to 5010.8], p=0.5428)

Conclusion: ICIs did not significantly increase the cost per life day in mUC treatment compared with chemotherapy alone and could be a treatment opinion worth trying in Taiwan.