维迪西妥单抗联合特瑞普利单抗一线治疗HER2表达局部晚期或转移性尿路上皮癌的成本-效用分析OA

OBJECTIVE To evaluate the cost-utility of disitamab vedotin(DV)combined with toripalimab versus platinum-containing chemotherapy as first-line therapy for locally advanced or metastatic urothelial carcinoma(UC)with human epidermal growth factor receptor 2(HER2)expression from the perspective of China's health-care system.METHODS A cost-utility analysis was performed.A three-state partitioned survival model was constructed based on the RC48-C016 trial with a 1-week cycle length.The long-term health benefits[quality-adjusted life years(QALYs)]and costs of disitamab vedotin combined with toripalimab versus platinum-containing chemotherapy as first-line therapy for locally advanced or metastatic UC with HER2 expression were simulated.The simulation time horizon was set to 15 years,and the discount rate was 4.5%.The willingness-to-pay(WTP)threshold was defined as twice China's per capita gross domestic product(GDP)in 2025(199 330 yuan/QALY).The incremental cost-effectiveness ratio(ICER)between the two groups was compared,and one-way sensitivity analysis and probabilistic sensitivity analysis were conducted.RESULTS Compared with platinum-containing chemotherapy regimen,the DV plus toripalimab regimen yielded an additional 1.01 QALYs with an incremental cost of 183 224.45 yuan,and the ICER was 181 728.15 yuan/QALY,which was below the WTP threshold.At the current threshold,the probability that the DV combination regimen had a cost-utility advantage was 79.9%.CONCLUSIONS Taking twice China's per capita GDP in 2025 as the WTP threshold,DV combined with toripalimab exhibits a cost-utility advantage over platinum-containing chemotherapy as first-line treatment for HER2-expressing locally advanced or metastatic urothelial carcinoma.