Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma
Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma
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DOI：
10.1002/cncr.20956
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发表时间：
2005-04-15
期刊：
影响因子：
6.2
通讯作者：
Best, JH
中科院分区：
文献类型：
--
作者：
Hornberger, JC;Best, JH
背景成人淋巴瘤研究组LNH 98-5研究的结果显示，利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）延长了年龄60岁的弥漫性大B细胞非霍奇金淋巴瘤（DLBCL）患者的无进展生存期和总生存期。本研究旨在探讨CHOP中加入利妥昔单抗（R-CHOP）与单独使用CHOP相比的增量成本效用。使用来自LNH 98-5研究（n = 399例患者）的已发表证据估计疾病进展和死亡时间的临床预后，该研究在数学上与DLBCL患者的已发表长期结局数据相关。药物采购成本基于处方集定价来源的已发表数据，癌症监测和临终关怀的成本基于已发表的文献来源。作者将成本效用评估为R-CHOP和CHOP之间的成本差异除以经生活质量调整的预期总生存期的增加。5年后，预计R-CHOP可延长总生存期1.04年。CHOP的平均累积成本为3358美元，R-CHOP的平均成本为17，225美元，导致累积净增加13，867美元。CHOP的治疗后癌症监测费用为3950美元，而R-CHOP为5202美元。据估计，当调整生活质量时，与CHOP相比，R-CHOP的成本效用比为19，297美元/年。在敏感性分析中，R-CHOP在广泛的变量范围内保持成本效益。与单独使用CHOP相比，预计R-CHOP在老年DLBCL患者中具有成本效益。(c)2005年美国癌症协会。
BACKGROUND. Findings from the Groupe d'Etude des Lymphomes Adultes LNH 98-5 study showed that rituximab added to combined cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) prolonged progression-free survival and overall survival in adults age : 60 years with diffuse large B-cell non-Hodgkin lymphoma (DLBCL). The current study was conducted to investigate the incremental cost utility of the addition of rituximab to CHOP (R-CHOP) compared with CHOP alone.METHODS. Clinical prognosis of the time to disease progression and death was estimated using published evidence from the LNH 98-5 study (n = 399 patients) that was linked mathematically to published long-term Outcome data on patients with DLBCL. Drug-acquisition costs were based on published data from formulary pricing sources, and the costs of cancer surveillance and end-of-life care were based on published literature sources. The authors assessed cost utility as the difference in costs between R-CHOP and CHOP divided by the increase in expected overall survival adjusted for quality of life.RESULTS. over 5 years, it was projected that R-CHOP would prolong overall survival by 1.04 years. The mean Cumulative cost of CHOP was $3358, and the mean cost of R-CHOP was $17,225, resulting in a cumulative net increase of $13,867. The posttreatment cancer surveillance cost for CHOP was $3950, compared with $5202 for R-CHOP. It was estimated that R-CHOP would have a cost-utility ratio of $19,297 per year of life gained compared with CHOP when adjusted for quality of life. R-CHOP remained cost effective over wide ranges of variables in sensitivity analyses.CONCLUSIONS. Compared with CHOP alone, it was predicted that R-CHOP would be cost effective in elderly patients with DLBCL. (c) 2005 American Cancer Society.