Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation.
Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation.
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自体干细胞移植后用 brentuximab vedotin 巩固治疗高危霍奇金淋巴瘤的成本效益分析。
DOI：
10.1002/cncr.30818
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发表时间：
2017-10-01
期刊：
影响因子：
6.2
通讯作者：
Huntington SF
中科院分区：
文献类型：
--
作者：
Hui L;von Keudell G;Wang R;Zeidan AM;Gore SD;Ma X;Davidoff AJ;Huntington SF
在最近的一项随机安慰剂对照试验中，维布妥昔单抗（BV）巩固治疗降低了自体干细胞移植（ASCT）后霍奇金淋巴瘤（HL）进展的风险。然而，BV巩固治疗对总生存率、生活质量和医疗费用的影响尚不清楚。我们构建了一个马尔可夫决策分析模型，以测量在ASCT后有HL复发风险的33岁患者队列中，BV巩固治疗与主动监测相比的成本和临床结局。计算每种ASCT后策略的终生成本、质量调整生命年（QRR）和增量成本效果比（ICER）。在生活质量调整和标准贴现后，与BV作为补救措施的主动监测相比，前期BV巩固与1.07质量调整生命年（QDs）的改善相关。然而，BV巩固策略导致医疗成本显著升高（378，832美元vs 219，761美元），导致BV巩固与主动监测相比的ICER为148，664美元/QALY。如果实施适应症特定定价，我们的模型估计，整合设置的BV价格降低18%至38%将分别转化为100，000美元/QALY和50，000美元/QALY的ICER。单向和概率敏感性分析的结果是一致的。以目前美国定价进行合并的BV在愿意支付100，000美元/QALY的门槛时不太可能具有成本效益。然而，在合并背景下，针对具体指标的降价可将ICER降低到广泛接受的数值。
In a recent randomized placebo-controlled trial, consolidation treatment with brentuximab vedotin (BV) decreased the risk of Hodgkin lymphoma (HL) progression after autologous stem-cell transplantation (ASCT). However, the impact of BV consolidation on overall survival, quality of life, and health care costs are unclear. We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for BV consolidation therapy compared to active surveillance in a 33-year-old patient cohort at risk for HL relapse following ASCT. Life-time costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each post-ASCT strategy. After quality-of-life adjustments and standard discounting, upfront BV consolidation was associated with an improvement of 1.07 quality-adjusted-life years (QALYs) compared to active surveillance with BV as salvage. However, the strategy of BV consolidation led to significantly higher healthcare costs ($378,832 versus $219,761), causing the ICER for BV consolidation compared with active surveillance to be $148,664/QALY. If indication-specific pricing were implemented, our model estimates BV price reductions of 18% to 38% for the consolidative setting would translate to ICERs of $100,000/QALY and $50,000/QALY, respectively. Findings were consistent on one-way and probabilistic sensitivity analyses. BV as consolidation at current US pricing is unlikely to be cost-effective at a willingness to pay threshold of $100,000/QALY. However, indication-specific price reductions for the consolidative setting could reduce ICERs to widely acceptable values.
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影响因子：
20.3
作者：
Gopal, Ajay K.;Chen, Robert;Younes, Anas
通讯作者：
Younes, Anas
影响因子：
6.8
作者：
AKAIKE, H
通讯作者：
AKAIKE, H
影响因子：
4.8
作者：
Brice, P;Bouabdallah, R;Colombat, P
通讯作者：
Colombat, P
影响因子：
4.3
作者：
Chen, Robert;Palmer, Joycelynne M.;Forman, Stephen J.
通讯作者：
Forman, Stephen J.
DOI：
10.1182/asheducation-2008.1.326
发表时间：
2008-01-01
期刊：
Hematology. American Society of Hematology. Education Program
影响因子：
--
作者：
Crump, Michael
通讯作者：
Crump, Michael