Cost-effectiveness of rituximab (MabThera®) in diffuse large B-cell lymphoma in the Netherlands
Cost-effectiveness of rituximab (MabThera®) in diffuse large B-cell lymphoma in the Netherlands
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DOI：
10.1111/j.1600-0609.2004.00368.x
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发表时间：
2005-03-01
影响因子：
3.1
通讯作者：
Uyl-de Groot, CA
中科院分区：
文献类型：
--
作者：
Groot, MT;Lugtenburg, PJ;Uyl-de Groot, CA
目的：确定环磷酰胺、多柔比星、长春新碱和泼尼松（CHOP）与CHOP+利妥昔单抗（R-CHOP）治疗荷兰弥漫性大B细胞淋巴瘤（DLBCL）患者的增量成本-效果比（ICER）。研究方法：开发了一种状态转换模型，以估计接受CHOP或R-CHOP初始治疗以达到ICER的II、III或IV期DLBCL患者的临床病程、成本和生活质量。成本分析的基准年是2002年，从社会角度进行。只包括直接医疗费用。该模型的时间范围为15年，成本和影响均以4%贴现。进行了敏感性分析，以确定模型的不同基线假设的影响。结果：在年轻和老年患者组中，质量调整生命年（Qs）的增量增益均为0.88。年轻患者组的成本高出e12 343，老年患者高出e15 860。这导致每增加一个QALY，年轻患者的ICER为e13 983，老年患者为e17 933。这些结果对模型的时间范围很敏感，其他变化对结果的影响很小。结论：在DLBCL的标准治疗中添加利妥昔单抗导致0.88 Qqs的增益。从疾病严重程度来看，大多数决策者在确定预算分配优先次序时，认为年轻患者每获得QALY的ICER为e13 983，老年患者为e17 933，是可以接受的。
Objective: To determine the incremental cost-effectiveness ratio (ICER) of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) vs. CHOP plus rituximab (R-CHOP) in diffuse large B-cell lymphoma (DLBCL) patients in the Netherlands. Methods: A state transition model was developed to estimate the clinical course, costs and quality of life of patients with stage II, III or IV DLBCL receiving initial treatment with CHOP or R-CHOP to arrive at the ICER. The base year for the cost analysis was 2002 and was performed from the societal perspective. Only direct medical costs were included. The time horizon of the model was 15 yr and both costs and effects were discounted at 4%. Sensitivity analyses were performed to determine the effect of varying base-line assumptions of the model. Results: The incremental gain in quality adjusted life years (QALYs) was 0.88 in both the younger and the older patient groups. The costs were e12 343 higher in the younger group of patients and e15 860 in the older patients. This resulted in an ICER of e13 983 for the younger and e17 933 for the older patients per QALY gained. These results were sensitive to the time horizon of the model, other variations had a marginal impact on the outcome. Conclusion: The addition of rituximab to standard therapy for DLBCL results in a gain of 0.88 QALYs. The ICER of e13 983 for younger and e17 933 for older patients per QALY gained should, seen in the light of disease severity, be considered acceptable by most policy makers in priority setting for budget allocation.