目的 从我国卫生体系出发，评价阿那曲唑、依西美坦、来曲唑辅助内分泌治疗激素受体（HR）阳性早期乳腺癌的经济性。方法 基于FATA-GIM3试验研究数据，建立Markov模型，以30 d为1个周期，模拟时限设置为30年，以质量调整生命年（QALY）作为健康产出指标，计算不同治疗方案的增量成本-效果比（ICER），并与1倍2025年我国人均国内生产总值（GDP）（99 665元·QALY^-1）作为意愿支付（WTP）阈值相比来评估治疗方案的经济性，并利用敏感性分析验证结果的稳健性。结果 基础分析结果显示，与阿那曲唑、来曲唑2组相比，依西美坦组治疗成本更高但获益更少，因此被认为是劣势方案。来曲唑组相对于阿那曲唑组的ICER值为245 695.913元·QALY^-1，高于本研究设定的WTP阈值。敏感性分析结果验证了基础结果的稳健性。结论 在以1倍2025年我国人均GDP作为WTP阈值的前提下，阿那曲唑相较于来曲唑和依西美坦是辅助内分泌治疗HR＋早期乳腺癌的首选方案。

Objective To evaluate the cost-effectiveness of anastrozole, exemestane, and letrozole as adjuvant endocrine therapy for hormone receptor (HR)-positive early breast cancer from the perspective of China’s healthcare system. Methods Based on the data from the FATA-GIM3 trial, a Markov model was established with a 30 d cycle and a simulation period of 30 years. Quality-adjusted life years (QALY) were used as the health outcome indicator. The incremental cost-effectiveness ratio (ICER) of different treatment regimens was calculated and compared with a willingness-to-pay (WTP) threshold of one time the per capita GDP of China in 2025 (99 665 yuan·QALY^-1) to assess the economic feasibility of the treatment regimens. Sensitivity analysis was performed to validate the robustness of the results. Results The baseline analysis revealed that exemestane resulted in higher treatment costs but lower benefits compared to anastrozole and letrozole, making it considered a less favorable option. The ICER of letrozole relative to anastrozole was 245 695.913 yuan·QALY^-1, exceeding the WTP threshold set in this study. Sensitivity analysis confirmed the robustness of the baseline results. Conclusion Under the premise of one time the per capita GDP of China in 2025 as the WTP threshold, anastrozole is the preferred adjuvant endocrine therapy for HR⁺ early breast cancer compared to letrozole and exemestane.

R965

河北省医学科学研究课题计划（20240241）；河北省医学科学研究课题计划（20211783）