Cost-effectiveness analysis of ramucirumab treatment for patients with hepatocellular carcinoma who progressed on sorafenib with α-fetoprotein concentrations of at least 400 ng/ml

Abstract

Objective: This study aimed to compare the cost-effectiveness of ramucirumab versus placebo for patients with hepatocellular carcinoma who progressed on sorafenib with α-fetoprotein concentrations (AFP) of at least 400?ng/ml in the United States.

Methods: A Markov model was constructed to assess the cost-effectiveness of ramucirumab. Health outcomes were measured as quality-adjusted life years (QALYs). With TreeAge software, the disease process was modeled as three health states: progression-free survival (PFS), progressive disease (PD), and death. Costs were extracted from the REACH-2 trial, and utility was derived from published literature. Incremental cost-effectiveness ratios (ICERs) were calculated to compare ramucirumab with placebo. Probabilistic sensitivity analyses were developed to examine the robustness of the results.

Results: In the base case analysis, ramucirumab therapy had a cost of $55,508.41 and generated 0.54 QALYs, while placebo therapy had a cost of $761.09 and generated 0.47 QALYs, leading to an additional $54,747.32 in costs and 0.07 QALYs. The ICER was $782,104.57 per QALY, which was much higher than the willingness-to-pay threshold of $100,000 per QALY. According to sensitivity analyses, the utility of PD in the two groups was the dominant parameter influencing the ICER.

Conclusion: Although ramucirumab was associated with prolonged survival for patients with advanced hepatocellular carcinoma who progressed on sorafenib treatment with an AFP of at least 400?ng/ml, it is not a cost-effective treatment from a United States payer perspective.     

"多轨制"养老金体系的收入差距——基于中国家庭收入调查数据的发现

从全国范围看,我国养老保险制度表现为"多轨制".本文利用中国家庭收入调查(CHIP)2013年和2018年数据,采用泰尔指数分解方法、基于回归模型的不平等分解方法、反事实分析方法等研究了养老金收入差距变动中的"多轨制"特点,其中重点关注了养老金的覆盖率变动和待遇水平变动的影响.研究发现:(1)从2013年到2018年,我国60岁及以上老年人的养老金收入差距缩小,养老金的覆盖率增加,养老金待遇水平提升.(2)通过反事实分析发现,覆盖率的增加是近几年养老金收入差距缩小的主要原因.养老金覆盖率的增加导致养老金收入基尼系数下降6.7个百分点,其中农村下降3.6个百分点,城镇下降了 8个百分点.(3)不同养老保险制度的待遇水平增速不统一,高收入人群总体上增速更快,从而扩大了养老金收入差距,使得基尼系数增加了 1.3个百分点.(4)新型农村居民社会养老保险待遇水平的提高有助于缩小养老金收入差距,对缩小农村养老金收入差距的作用更大,使得农村养老金收入基尼系数下降了 2.4个百分点.在今后的养老保险制度改革中,需要继续提高养老金覆盖率,平衡职工养老金和居民社会养老金的增速,切实提高低收入家庭的待遇水平,缩小我国老年群体的养老金收入不平等.