Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, NSW, Australia.
Intern Med J. 2009 Aug;39(8):519-26. doi: 10.1111/j.1445-5994.2008.01795.x.
Since 1995 patients with relapsed aggressive non-Hodgkin lymphoma have been treated with high-dose chemotherapy (HDC) instead of standard dose chemotherapy (SC) because of superior survival shown in the 'Parma study'. As HDC involves hospital admission and intensive supportive care, the cost of HDC would be predicted to be higher than for SC. The aim of this study was to calculate the incremental cost-effectiveness ratio for HDC compared with SC using Australian costs.
Cost of treatment was determined on 21 patients receiving HDC with characteristics similar to the Parma study from the HDC database of the Calvary Mater Newcastle Hospital. Drug, transfusion, inpatient and outpatient attendance and additional relevant data from start of treatment for relapse and up to 100 days following HDC were obtained and costed. SC costs required modelling as all suitable patients are planned to receive HDC if possible; therefore there are no concurrent SC arms. A lifetime estimate of patient years gained by HDC versus SC was calculated from the area under survival curves (AUC) of HDC and SC. The incremental cost-effectiveness ratio was calculated according to the following formula:
Costs for HDC and SC were A$37 490 and A$33 360, respectively, and the AUC(0-infinity) were 4.09 and 3.5 patient life years, respectively, giving an incremental cost-effectiveness ratio of A$7070 per discounted life year gained.
Compared with published studies in multiple myeloma and solid organ transplant, these results support HDC as a cost-effective treatment in relapsed aggressive non-Hodgkin lymphoma.
自 1995 年以来，由于“帕尔马研究”显示出更高的生存率，复发侵袭性非霍奇金淋巴瘤患者已接受高剂量化疗（HDC）而非标准剂量化疗（SC）治疗。由于 HDC 需要住院和强化支持治疗，因此预计 HDC 的成本会高于 SC。本研究旨在使用澳大利亚成本计算 HDC 与 SC 相比的增量成本效益比。
从卡瓦利·马瑟·纽卡斯尔医院的 HDC 数据库中确定了 21 名接受 HDC 治疗且特征与帕尔马研究相似的患者的治疗成本。从复发开始和 HDC 后 100 天内的治疗开始，获取并计价药物、输血、住院和门诊就诊以及其他相关数据。由于所有合适的患者都计划尽可能接受 HDC，因此需要对 SC 成本进行建模；因此，没有同时进行 SC 治疗的患者。根据 HDC 和 SC 的生存曲线下面积（AUC）计算 HDC 与 SC 相比获得的患者年度增量。根据以下公式计算增量成本效益比：
HDC 和 SC 的成本分别为 37490 澳元和 33360 澳元，AUC（0 至无穷大）分别为 4.09 和 3.5 个患者生命年，这意味着每获得一个贴现生命年的增量成本效益比为 7070 澳元。
与多发性骨髓瘤和实体器官移植的多项已发表研究相比，这些结果支持 HDC 作为复发侵袭性非霍奇金淋巴瘤的一种具有成本效益的治疗方法。
