RESUMO
INTRODUCTION: Results from the CASPIAN trial (Durvalumab ± Tremelimumab in Combination With Platinum Based Chemotherapy in Untreated Extensive-Stage Small Cell Lung Cancer) trial demonstrated the clinical benefit of durvalumab plus etoposide-platinum (EP) chemotherapy as first-line treatment for patients with extensive stage small-cell lung cancer (ES-SCLC). However, considering the high price of durvalumab, it is unclear whether addition of durvalumab to EP chemotherapy has economic value compared with EP alone. In this study, we aimed to evaluate the cost-effectiveness of durvalumab plus EP chemotherapy as a first-line treatment for patients with ES-SCLC. METHODS: A Markov model comprising three health states (stable, progressive, and dead) was developed to simulate the process of small-cell lung cancer. Utility and costs were obtained from published resources. Health outcomes were derived from the CASPIAN trial. Costs were calculated based on the standard medical fees in Zhejiang Province from Chinese patients' perspective. Utility values were obtained from published data. One-way and probabilistic sensitivity analyses were applied to verify model robustness. RESULTS: The addition of durvalumab to EP chemotherapy costs more than $32,220, with a gain of 0.14 quality-adjusted life years (QALYs) compared with EP alone. The incremental cost-effective ratio was $230,142.9 per QALY, which exceeds the willingness to pay threshold of $28,527 per QALY. In the sensitivity analysis, the utility values for the progressive state, costs of durvalumab and EP chemotherapy, and costs for the progressive state were considered to be the three most sensitive factors in the model. CONCLUSION: The addition of durvalumab to EP chemotherapy is not a cost-effective strategy in the first-line therapy of ES-SCLC from the Chinese payers' perspective.
Assuntos
Análise Custo-Benefício/economia , Platina/uso terapêutico , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Carcinoma de Pequenas Células do Pulmão/economia , Anticorpos Monoclonais/economia , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/economia , Anticorpos Monoclonais Humanizados/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , China/epidemiologia , Etoposídeo/economia , Etoposídeo/uso terapêutico , Feminino , Humanos , Masculino , Cadeias de Markov , Estadiamento de Neoplasias , Platina/economia , Intervalo Livre de Progressão , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Carcinoma de Pequenas Células do Pulmão/patologiaRESUMO
RuO2/TiQ2 coupled photocatalyst was prepared by sol-gel-dipping method. Being a model reaction, the photocatalytic degradation of direct fast black G was investigated in RuO2/TiO2 powder suspension irradiated by UV-lamp. The results showed that the addition of RuO2 to TiO2 greatly enhanced its photocatalytic activity, and the optimum dipped content of RuO2 was 0.16%, the optimum value of the calcinations temperature and the addition of RuO2/TiO2 powder were 500 degrees C and 5.00 g x L(-1), respectively. The photocatalytic degradation of direct fast black G was experimentally demonstrated to follow the Langmuir-Hinshelwood kinetic model, and the adsorption constant (14.22 L x mmol(-1)) and the reaction rate constant [4.94 x 10(-3) mmol(L x min)(-1)] were determined, respectively.