F. Hoffmann-La Roche, Ltd., Basel, Switzerland.
Value Health. 2010 Jun-Jul;13(4):346-57. doi: 10.1111/j.1524-4733.2009.00676.x. Epub 2010 Jan 8.
In this study, the cost-effectiveness of rituximab was evaluated in comparison with commonly used chemotherapy regimens for patients with advanced follicular lymphoma (FL), from the perspective of the UK National Health Service (NHS).
Results from four randomized controlled trials comparing the addition of rituximab to chemotherapy regimens: mitoxantrone, chlorambucil, and prednisolone (MCP); cyclophosphamide, vincristine, and prednisolone (CVP); cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP); or cyclophosphamide, etoposide, doxorubicin, prednisolone, and interferon alpha (CHVP + IFNalpha) versus chemotherapy alone were used to develop a Markov model. The rates of disease progression and the duration of treatment effect were obtained from the trial data. Treatments were compared in two ways: 1) an individual comparison of rituximab + chemotherapy versus chemotherapy and 2) a multiple treatment comparison using league tables. Economic and clinical outcomes (quality-adjusted life-years (QALYs)) were estimated over patient lifetimes and discounted at 3.5% per annum.
In the individual comparison, the addition of rituximab increased QALYs by (mean, 95% confidence interval) 1.174 (1.02-1.30), 0.909 (0.79-1.01), 0.823 (0.71-0.91), and 0.453 (0.40-0.50) for MCP, CVP, CHOP, and CHVP, respectively, compared with chemotherapy alone. The incremental costs per QALY gained were pound7474, pound8621, pound10,732, and pound8551, respectively. Sensitivity analyses indicated that rituximab plus chemotherapy was a cost-effective treatment option, with incremental cost-effectiveness ratios below a threshold of pound30,000 per QALY gained. When compared across the chemotherapy regimens, rituximab plus MCP appeared to be the single most cost-effective treatment option, but further randomized trials are required to substantiate this.
The addition of rituximab to chemotherapy in advanced FL was found to be highly cost-effective in the UK.
本研究从英国国家医疗服务体系（NHS）的角度出发，评估利妥昔单抗对比常用化疗方案治疗晚期滤泡性淋巴瘤（FL）的成本效益。
我们使用四项比较利妥昔单抗联合化疗方案（米托蒽醌、苯丁酸氮芥和泼尼松[MCP]；环磷酰胺、长春新碱和泼尼松[CVP]；环磷酰胺、多柔比星、长春新碱和泼尼松[CHOP]；或环磷酰胺、依托泊苷、多柔比星、泼尼松和干扰素α[CHVP + IFNalpha]）与单纯化疗比较的随机对照试验结果，构建了一个马尔可夫模型。从试验数据中获取疾病进展率和治疗效果持续时间。采用两种方法比较治疗方法：1）利妥昔单抗联合化疗与单纯化疗的个体比较；2）使用联赛表进行的多种治疗比较。对患者寿命内的经济和临床结果（质量调整生命年[QALYs]）进行估计，并按每年 3.5%贴现。
在个体比较中，与单纯化疗相比，利妥昔单抗的添加分别使 MCP、CVP、CHOP 和 CHVP 的 QALY 增加（均值，95%置信区间）1.174（1.02-1.30）、0.909（0.79-1.01）、0.823（0.71-0.91）和 0.453（0.40-0.50）。每个 QALY 获得的增量成本分别为 7474 英镑、8621 英镑、10732 英镑和 8551 英镑。敏感性分析表明，利妥昔单抗联合化疗是一种具有成本效益的治疗选择，增量成本效益比低于每获得一个 QALY 30000 英镑的阈值。当与化疗方案进行比较时，利妥昔单抗联合 MCP 似乎是最具成本效益的单一治疗选择，但需要进一步的随机试验来证实这一点。
在英国，利妥昔单抗联合化疗治疗晚期 FL 具有很高的成本效益。
