1.Cost-utility analysis of tislelizumab monotherapy for second-line treatment of advanced or metastatic esophageal squamous cell carcinoma
Enhui WEN ; Chuan GAO ; Juanni DONG ; Lihui LONG ; Biaoxue RONG
China Pharmacy 2023;34(5):581-586
OBJECTIVE To evaluate the cost-effectiveness of tislelizumab monotherapy in the second-line treatment of advanced or metastatic esophageal squamous cell carcinoma (ESCC),so as to provide reference for rational use of drug in clinic. METHODS A three-state partitioned survival model was constructed from the perspective of China’s health system, based on the data of RATIONALE-302 study,with simulation time limit of 10 years, cycle period of 1 month. The incremental cost-effectiveness ratio (ICER) was calculated with quality-adjusted life year (QALY) as utility index. The cost-effectiveness of tislelizumab monotherapy was compared with that of chemotherapy for second-line treatment of advanced or metastatic ESCC by cost-utility analysis. The stability of basic analysis results was validated through sensitivity analysis and scenario analysis. RESULTS The results of basic analysis showed that compared with chemotherapy group, incremental cost per capita of tislelizumab group was 35 025.32 yuan,and incremental utility per capita was 2.71 QALYs; ICER was 12 892.31 yuan/QALY, which was far lower than the willingness-to-pay (WTP) threshold of 3 times of China’s per capita gross domestic product (GDP) 242 928 yuan in 2021. The results of univariate sensitivity analysis showed that parameters such as the cost of apatinib, the utility value of disease progression status and the cost of adverse reactions in the chemotherapy group had a great impact on the ICER value, but these parameters could not cause the reversal of the basic analysis results. Probabilistic sensitivity analysis showed that WTP threshold was higher than 80 000 yuan/QALY,the probability of tislelizumab monotherapy possessed cost-effectiveness was 100%. Results of scenario analysis showed that in which model simulation time lasted for 5 or 20 years,ICER of tislelizumab was 8 331.00 yuan/QALY and 12 981.00 yuan/QALY, which were less than 3 times of China’s per capita GDP in 2021 as WTP threshold. CONCLUSIONS When three times of China’s GDP per capita in 2021 is taken as the WTP threshold, the second-line treatment of tirelizumab monotherapy for advanced or metastatic ESCC is more cost-effective than chemotherapy.
2.Effect of fisetin against venous thrombosis in rats and its mechanism
Lihui LONG ; Shuang WEI ; Qing LIU ; Yang YAO ; Juanni DONG ; Yuanyuan CHANG ; Enhui WEN
Journal of Xi'an Jiaotong University(Medical Sciences) 2024;45(3):383-387
【Objective】 To analyze the effect of fisetin against venous thrombosis in rats. 【Methods】 Seventy SD rats were randomly divided into the following groups: sham-operation group, model group, fisetin 45 mg/kg, 15 mg/kg, 5 mg/kg groups, and aspirin group (47 mg/kg). The corresponding medication was administered by gavage once a day consecutively (the sham-operation group and the model group were given 0.5% carboxymethyl cellulose sodium solution with 10 mL/kg, respectively) for 7 consecutive days. One hour after the last administration, the rats were anesthetized, the lower part of the intersection of inferior vena cava and left renal vein was ligated with silk thread (no ligation in the sham-operation group), and the abdominal wall was sutured. Two hours later, the abdominal cavity was reopened, the other venous branches 1.5 cm away from the ligation site were closed with the artery clamp, and blood was collected from the abdominal aorta. The anticoagulant ratio of 3.8% sodium citrate∶whole blood was 1∶9.The venous thrombus 1 cm down from the ligation point of the intersection of inferior vena cava and left renal vein was cut and the thrombus was separated. The residual blood was dried with filter paper, weighed and recorded. Plasma was taken after anticoagulant blood centrifugation. The levels of plasma antithrombin-Ⅲ (AT-Ⅲ), protease C (PC), plasminogen (PLG), and plasminogen activator inhibitor (PAI-1) were detected by ELISA kits. 【Results】 Compared with the model group, the weight of thrombus in fisetin 45 mg/kg group and aspirin 47 mg/kg group decreased (P<0.01). The content of AT-Ⅲ in three fisetin groups increased (all P<0.05). The content of PC in fisetin 45 mg/kg increased (P<0.05). The content of PLG and PAI-1 in fisetin 45 mg/kg group decreased (both P<0.05). 【Conclusion】 Fisetin has the effect against venous thrombosis in vivo, and the effect is related to the upregulation of AT-Ⅲ and PC and the downregulation of PLG and PAI-1.