Catalyst Health Economics Consultants, Northwood, Middlesex, United Kingdom; Postgraduate Medical School, University of Surrey, Guildford, Surrey, United Kingdom.
Clin Ther. 2009;31 Pt 2:2398-415. doi: 10.1016/j.clinthera.2009.11.016.
This article assesses the cost-effectiveness of pentostatin compared with cladribine in the management of hairy cell leukemia (HCL) in the United Kingdom.
A systematic literature search for papers on HCL was performed using MEDLINE, EMBASE, Current Contents, NHS Economic Evaluation Database, and the Cochrane computerized database. Search terms were HCL plus 1 of the following: incidence, prevalence, epidemiology, cladribine, interferon, pentostatin, rituximab, splenectomy, utility, quality of life, cost-effectiveness, cost-utility, resource utilization, economic, or cost. Published clinical outcomes and estimates of health care resource use obtained from 10 consultant hematologists across the United Kingdom were used to construct a 5-year Markov model depicting the current management of HCL in the United Kingdom. Utilities for health states in the model were obtained from the general public using standard gamble, time tradeoff, and visual analog scale techniques. The model was used to consider the decision by a clinician to initially treat an HCL patient with either pentostatin or cladribine and to estimate the relative cost-effectiveness of pentostatin over 5 years (at 2007/2008 prices) from the perspective of the UK's National Health Service (NHS).
According to the model, 64% of all pentostatin-treated patients are expected to be in relapse-free remission at 5 years compared with 49% of cladribine-treated patients (P = 0.04). Repeat treatment of initial partial responders, nonresponders, and those who relapse during the 5 years is expected to result in complete remission in 92% of pentostatintreated patients and 90% of cladribine-treated patients at 5 years. Using pentostatin instead of cladribine is expected to lead to a minimal cost increase (from 21,325 pounds to 21,609 pounds) and an improvement in health status (from 3.64 to 3.77 quality-adjusted life-years [QALYs]) over 5 years. Hence, the cost per QALY gained from using pentostatin is expected to be 5000 pounds. Moreover, pentostatin has a 0.90 probability of being cost-effective for a threshold of 20,000 pounds per QALY. Accordingly, using pentostatin as a first-line treatment for patients with HCL is an effective use of NHS resources.
Based on current practice, this model predicts that pentostatin is a cost-effective treatment compared with cladribine in the management of HCL from the perspective of the UK's NHS.
本文评估喷司他丁治疗英国慢性淋巴细胞白血病（HCL）的成本效益，与克拉屈滨相比。
使用 MEDLINE、EMBASE、Current Contents、NHS 经济评估数据库和 Cochrane 计算机数据库，对 HCL 相关文献进行了系统检索。检索词为 HCL 加以下之一：发病率、患病率、流行病学、克拉屈滨、干扰素、喷司他丁、利妥昔单抗、脾切除术、效用、生活质量、成本效益、成本效用、资源利用、经济或成本。从英国的 10 位顾问血液病学家那里获得了已发表的临床结果和医疗资源使用估计值，用于构建 5 年 Markov 模型，描述英国目前对 HCL 的管理。模型中的健康状态效用是通过标准博弈、时间权衡和视觉模拟量表技术从公众中获得的。该模型用于考虑临床医生最初用喷司他丁或克拉屈滨治疗 HCL 患者的决策，并估计从英国国家卫生服务局（NHS）的角度来看，喷司他丁在 5 年内的相对成本效益（以 2007/2008 年的价格计算）。
根据模型，与克拉屈滨治疗组的 49%相比，预计 64%的喷司他丁治疗患者在 5 年内无复发缓解（P = 0.04）。对初始部分缓解、无反应和复发患者进行重复治疗，预计喷司他丁治疗组 92%和克拉屈滨治疗组 90%的患者在 5 年内可达到完全缓解。与克拉屈滨相比，使用喷司他丁可导致成本略有增加（从 21325 英镑增加到 21609 英镑），并在 5 年内提高健康状况（从 3.64 增加到 3.77 个质量调整生命年[QALYs]）。因此，预计使用喷司他丁的每 QALY 成本为 5000 英镑。此外，喷司他丁在 20000 英镑/QALY 的阈值下具有 0.90 的成本效益概率。因此，在 NHS 资源方面，喷司他丁作为 HCL 患者的一线治疗是一种有效的治疗方法。
基于当前实践，该模型预测，从英国 NHS 的角度来看，与克拉屈滨相比，喷司他丁是一种治疗 HCL 的具有成本效益的药物。
