Hornberger John, Reyes Carolina, Lubeck Deborah, Valente Nancy
Cedar Associates LLC, Menlo Park, CA, USA.
Leuk Lymphoma. 2008 Feb;49(2):227-36. doi: 10.1080/10428190701769665.
The addition of rituximab to cyclophosphamide, vincristine and prednisolone (CVP) for advanced follicular lymphoma increases median time to progression by 17 months. A US societal cost-effectiveness of R-CVP versus CVP is estimated for a representative 50-year-old patient. Progression-free survival (PFS) and overall survival are based on a randomized Phase III trial. Costs are estimated using Medicare reimbursement rates and published drug price data, and include drug and administration costs, adverse events, treatment of relapses, and end-of-life care. Utility estimates are derived from the literature and a 3% discount rate is employed. Mean overall survival is projected to be 1.51 years longer for patients assigned to R-CVP versus CVP. The cost per quality-adjusted year of life gained is $28,565. The utility associated with stable or progressive disease and the unit drug cost of rituximab most influence the findings. The cost-effectiveness ratio of R-CVP compared with CVP is projected to be cost-effective in the United States under a range of sensitivity analyses.
对于晚期滤泡性淋巴瘤，在环磷酰胺、长春新碱和泼尼松（CVP）方案中添加利妥昔单抗可使中位进展时间延长17个月。针对一名具有代表性的50岁患者，评估了R-CVP与CVP在美国的社会成本效益。无进展生存期（PFS）和总生存期基于一项随机III期试验。成本使用医疗保险报销率和已公布的药品价格数据进行估算，包括药品和给药成本、不良事件、复发治疗以及临终护理。效用估计值来自文献，并采用3%的贴现率。预计分配到R-CVP组的患者的平均总生存期比CVP组患者长1.51年。每获得一个质量调整生命年的成本为28,565美元。与病情稳定或进展相关的效用以及利妥昔单抗的单位药品成本对研究结果影响最大。在一系列敏感性分析下，R-CVP与CVP相比的成本效益比预计在美国具有成本效益。
