目的：与例行监测相比，Niraparib可以改善铂敏感复发性卵巢癌（PSROC）患者的生存时间，但伴随着增加的费用。基于NORA试验，我们首次评估了中国个体化起始剂量（ISD）维持性Niraparib的经济效益。方法：建立了马尔科夫模型，模拟了每种策略的费用和健康结果。测量了总费用、质调整生命年（QALY）和增量费用效益比（ICER）。进行了一维和概率敏感性分析，以估计模型的稳健性。还进行了情景分析。结果：与例行监测相比，Niraparib在有无生殖系BRCA（gBRCA）突变的人群中，QALY分别增加了0.59和0.30，增量费用分别为10,860.79美元和12,098.54美元。Niraparib相对于例行监测的ICER分别为18,653.67美元/QALY和39,212.99美元/QALY。在37,488美元/QALY的意愿支付（WTP）阈值下，ISD提高了gBRCA突变组中从9.35％到30.73％的经济效益概率，以及非gBRCA突变人群中从0.77％到11.74％的概率。在中国人均国内生产总值最高的地区，Niraparib 在gBRCA突变和非gBRCA突变人群中分别有74.23％和76.10％的经济效益概率。针对上述WTP阈值，对于全国基本医疗保险受益人，Niraparib的经济效益为100%。结论：与例行监测相比，对于PSROC的维持治疗，gBRCA突变人群中的Niraparib的ISD是经济有效的，在非gBRCA突变患者中则更加有效但代价高昂。优化的Niraparib价格、经济地位和医疗保险覆盖可能有助于领域经济结果。 版权所有 © 2023 Shi, Xiao, Li, Liu and Zhang.

Objective: Niraparib improved survival in platinum-sensitive recurrent ovarian cancer (PSROC) patients versus routine surveillance, accompanied by increased costs. Based on the NORA trial, we evaluated for the first time the cost-effectiveness of maintenance niraparib with individualized starting dosage (ISD) in China. Methods: A Markov model was developed to simulate the costs and health outcomes of each strategy. The total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured. One-way and probabilistic sensitivity analysis were performed to estimate model robustness. Scenario analyses were also conducted. Results: Compared to routine surveillance, niraparib additionally increased QALYs by 0.59 and 0.30 in populations with and without germline BRCA (gBRCA) mutations, with incremental costs of $10,860.79 and $12,098.54, respectively. The ICERs of niraparib over routine surveillance were $18,653.67/QALY and $39,212.99/QALY. At a willingness-to-pay (WTP) threshold of $37,488/QALY, the ISD enhanced the likelihood of cost-effectiveness from 9.35% to 30.73% in the gBRCA-mutated group and from 0.77% to 11.74% in the non-gBRCA mutated population. The probability of niraparib being cost-effective in the region with the highest per capita Gross Domestic Product (GDP) in China was 74.23% and 76.10% in the gBRCA-mutated and non-gBRCA mutated population, respectively. Niraparib was 100% cost-effective for National Basic Medical Insurance beneficiaries under the above WTP thresholds. Conclusion: Compared to routine surveillance, the ISD of niraparib for maintenance treatment of PSROC is cost-effective in the gBRCA-mutated population and more effective but costly in the non-gBRCA mutated patients. The optimized niraparib price, economic status, and health insurance coverage may benefit the economic outcome.Copyright © 2023 Shi, Xiao, Li, Liu and Zhang.