SHE , Brussels , Belgium.
J Med Econ. 2014 Feb;17(2):111-24. doi: 10.3111/13696998.2013.873044. Epub 2014 Jan 13.
To evaluate the cost-effectiveness of bendamustine-rituximab (B-R) compared with CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab) and CVP-R (cyclophosphamide, vincristine, prednisone, rituximab) as first-line treatment for patients with advanced indolent non-Hodgkin's lymphoma (NHL).
A patient-level simulation was adapted from the model used by the University of Sheffield School of Health and Related Research (ScHARR) in a health technology appraisal of rituximab for first-line treatment of follicular lymphoma. This approach allowed modelling of the complex treatment pathways in indolent NHL. Data from a Phase 3 randomized, open-label trial were used to compare B-R with CHOP-R. The relative efficacy of CHOP-R and CVP-R was estimated using an indirect treatment comparison similar to the original ScHARR approach. The analysis was conducted from the perspective of the National Health Service in England and Wales, using a lifetime time horizon. A number of one-way sensitivity and scenario analyses were conducted, including one using recently published data comparing CVP-R with CHOP-R.
The deterministic incremental cost-effectiveness ratio (ICER) was £5249 per quality adjusted life year (QALY) for B-R vs CHOP-R, and £8092 per QALY for B-R vs CVP-R. The alternative scenario using direct data comparing CVP-R with CHOP-R approximately halved the ICER for B-R vs CVP-R to £4733. Owing to its better toxicity profile, B-R reduced the cost of treating adverse events by over £1000 per patient vs CHOP-R.
The main limitations were: immaturity of overall survival data from the Phase 3 trial; reliance on quality-of-life data from previous health technology appraisals (as this was not collected in the trial); and a lack of direct evidence or a network of connected evidence comparing B-R with CVP-R.
The ICERs for B-R vs CHOP-R and CVP-R were considerably below the thresholds normally regarded as cost-effective in England and Wales (£20,000-30,000 per QALY).
评估苯达莫司汀-利妥昔单抗（B-R）与 CHOP-R（环磷酰胺、多柔比星、长春新碱、泼尼松、利妥昔单抗）和 CVP-R（环磷酰胺、长春新碱、泼尼松、利妥昔单抗）相比，作为晚期惰性非霍奇金淋巴瘤（NHL）患者一线治疗的成本效益。
从谢菲尔德大学健康与相关研究学院（ScHARR）在利妥昔单抗用于滤泡性淋巴瘤一线治疗的卫生技术评估中使用的模型改编了一个患者水平模拟，该方法允许对惰性 NHL 的复杂治疗途径进行建模。使用 3 期随机、开放标签试验的数据比较 B-R 与 CHOP-R。使用与原始 ScHARR 方法相似的间接治疗比较来估计 CHOP-R 和 CVP-R 的相对疗效。该分析从英格兰和威尔士国家医疗服务体系的角度进行，使用终身时间范围。进行了一系列单因素敏感性和情景分析，包括使用最近发表的比较 CVP-R 与 CHOP-R 的数据的一项分析。
B-R 与 CHOP-R 相比，每质量调整生命年（QALY）的确定性增量成本效益比（ICER）为 5249 英镑，B-R 与 CVP-R 相比，每 QALY 的 ICER 为 8092 英镑。使用直接比较 CVP-R 与 CHOP-R 的直接数据的替代方案将 B-R 与 CVP-R 的 ICER 降低了近一半，降至 4733 英镑。由于其更好的毒性特征，B-R 使治疗不良事件的成本比 CHOP-R 降低了每位患者 1000 多英镑。
主要局限性是：3 期试验的总生存数据不成熟；依赖于之前卫生技术评估的生活质量数据（因为这在试验中没有收集）；缺乏直接证据或比较 B-R 与 CVP-R 的网络连接证据。
B-R 与 CHOP-R 和 CVP-R 的 ICER 远低于英格兰和威尔士通常认为具有成本效益的阈值（每 QALY20000-30000 英镑）。
