Chhatwal Jagpreet, Mathisen Michael, Kantarjian Hagop
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Epocrates Medical Information, AthenaHealth, San Francisco, California.
Cancer. 2015 Oct 1;121(19):3372-9. doi: 10.1002/cncr.29512. Epub 2015 Jun 23.
In the past 15 years, treatment outcomes for hematologic malignancies have improved substantially. However, drug prices have also increased drastically. This commentary examines the value of the treatment of hematologic malignancies at current prices in the United States through a reanalysis of a systematic review evaluating 29 studies of 9 treatments for 4 hematologic malignancies. Incremental cost-effectiveness ratios (ICERs) were calculated on the basis of drug prices in the United States in 2014. Sixty-three percent of the studies (15 of 24) had ICERs higher than $50,000 per quality-adjusted life-year (QALY), the benchmark widely used by health economists to define cost-effectiveness. In studies evaluating the current standard-of-care treatments for chronic myeloid leukemia, the ICERs for tyrosine kinase inhibitors versus hydroxyurea or interferon ranged from $210,000 to $426,000/QALY. The lower ICER values were mostly obtained from 11 studies evaluating rituximab, which was approved by the Food and Drug Administration in 1997 (ICER range, $37,000-$69,000/QALY). In conclusion, the costs of the majority of new treatments for hematologic cancers are too high to be deemed cost-effective in the United States.
在过去15年中，血液系统恶性肿瘤的治疗效果有了显著改善。然而，药品价格也急剧上涨。本评论通过重新分析一项系统评价来审视美国当前价格下血液系统恶性肿瘤治疗的价值，该系统评价评估了针对4种血液系统恶性肿瘤的9种治疗方法的29项研究。增量成本效益比（ICER）是根据2014年美国的药品价格计算得出的。63%的研究（24项中的15项）的ICER高于每质量调整生命年（QALY）50,000美元，这是卫生经济学家广泛用于定义成本效益的基准。在评估慢性髓性白血病当前标准治疗方法的研究中，酪氨酸激酶抑制剂与羟基脲或干扰素相比的ICER为每QALY 210,000美元至426,000美元。较低的ICER值大多来自11项评估利妥昔单抗的研究，该药物于1997年获得美国食品药品监督管理局批准（ICER范围为每QALY 37,000美元至69,000美元）。总之，在美国，大多数血液系统癌症新治疗方法的成本过高，难以被视为具有成本效益。
