目的 评价卡瑞利珠单抗联合化疗方案一线治疗复发或转移性鼻咽癌的经济性。方法 构建分区生存模型，模拟患者的质量调整生命年（QALY）和增量成本效果比（ICER），并进行单因素敏感性分析、概率敏感性分析和情境分析来检验模型的不确定性。结果 基础分析结果显示，相较于传统安慰剂联合化疗方案，使用卡瑞利珠单抗联合化疗方案一线治疗复发或转移性鼻咽癌的 ICER为 91 570.87元/QALY，远低于我国 3倍人均 GDP；单因素敏感性分析显示对模型结果影响程度最大的3个因素分别是无进展生存状态（PFS）的效用值、卡瑞利珠单抗成本及疾病进展后成本；概率敏感性分析显示，当意愿支付值大于15万元，卡瑞利珠单抗对比安慰剂联合顺铂和吉西他滨（GP方案）更具经济性的概率为100%；情境分析验证了基础分析的稳健性。结论 在我国3倍人均GDP的意愿支付值下，使用卡瑞利珠单抗联合GP方案一线治疗复发或转移性鼻咽癌更具经济性。

Objective To evaluate the economics of the first-line treatment of recurrent or metastatic nasopharyngeal carcinoma with camrelizumab in combination with a chemotherapy regimen.Methods A compartmentalized survival model was constructed to simulate patients' quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER), and univariate sensitivity analyses, probabilistic sensitivity analyses, and situational analyses were performed to test the model's uncertainty.Results The results of the baseline analysis showed that the ICER for first-line treatment of recurrent or metastatic nasopharyngeal carcinoma using camrelizumab in combination with chemotherapy regimen was 91 570.87 RMB/QALY compared with the traditional placebo combination chemotherapy regimen, which was much lower than three times the per capita GDP in China. The one-way sensitivity analysis showed that the three factors with the greatest degree of influence on the model results were progression-free survival (PFS) status utility value, cost of camrelizumab, and cost after disease progression. Probabilistic sensitivity analysis showed that when the willingness-to-pay value was greater than 150 000 RMB, the probability that camrelizumab was more economical than placebo combined with cisplatin and gemcitabine (GP regimen) was 100%. And situational analysis verified the robustness of the underlying analysis.Conclusion With a willingness-to-pay value of three times our per capita GDP, first-line treatment of recurrent or metastatic nasopharyngeal carcinoma is more economical with the use of camrelizumab in combination with a GP regimen.

R739

福建省卫生健康委员会中青年骨干人才培养项目（2022GGA010）