奥妥珠单抗治疗荷兰慢性淋巴细胞白血病的成本效益
Cost-effectiveness of obinutuzumab for chronic lymphocytic leukaemia in The Netherlands.
作者信息
Blommestein Hedwig M, de Groot Saskia, Aarts Mieke J, Vemer Pepijn, de Vries Robin, van Abeelen Annet F M, Posthuma E F M Ward, Uyl-de Groot Carin A
机构信息
Institute for Medical Technology Assessment, Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Netherlands Comprehensive Cancer Organisation, Netherlands Cancer Registry Utrecht, The Netherlands.
Institute for Medical Technology Assessment, Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
出版信息
Leuk Res. 2016 Nov;50:37-45. doi: 10.1016/j.leukres.2016.09.005. Epub 2016 Sep 3.
BACKGROUND
Obinutuzumab combined with chlorambucil (GClb) has shown to be superior to rituximab combined with chlorambucil (RClb) and chlorambucil (Clb) in newly diagnosed patients with chronic lymphocytic leukaemia (CLL). This study evaluates the cost-effectiveness per life-year and quality-adjusted life-year (QALY) of GClb compared to RClb, Clb, and ofatumumab plus chlorambucil (OClb) in The Netherlands.
METHODS
A Markov model was developed to assess the cost-effectiveness of GClb, RClb, Clb and other treatments in the United Kingdom. A country adaptation was made to estimate the cost-effectiveness of these therapies in The Netherlands using Dutch unit costs and Dutch data sources for background mortality and post-progression survival.
RESULTS
An incremental gain of 1.06 and 0.64 QALYs was estimated for GClb compared to Clb and RClb respectively, at additional costs of €23,208 and €7254 per patient. Corresponding incremental cost-effectiveness ratios (ICERs) were €21,823 and €11,344 per QALY. Indirect treatment comparisons showed an incremental gain varying from 0.44 to 0.77 QALYs for GClb compared to OClb and additional costs varying from €7041 to €5028 per patient. The ICER varied from €6556 to €16,180 per QALY. Sensitivity analyses showed the robustness of the results.
CONCLUSION
GClb appeared to be a cost-effective treatment strategy compared to RClb, OClb and Clb.
背景
在新诊断的慢性淋巴细胞白血病（CLL）患者中，奥妥珠单抗联合苯丁酸氮芥（GClb）已显示出优于利妥昔单抗联合苯丁酸氮芥（RClb）和苯丁酸氮芥（Clb）。本研究评估了在荷兰，与RClb、Clb以及奥法木单抗联合苯丁酸氮芥（OClb）相比，GClb每生命年和质量调整生命年（QALY）的成本效益。
方法
开发了一个马尔可夫模型来评估GClb、RClb、Clb及其他治疗方案在英国的成本效益。进行了国别适应性调整，以使用荷兰单位成本和荷兰背景死亡率及进展后生存率的数据源来估计这些疗法在荷兰的成本效益。
结果
与Clb和RClb相比，GClb估计分别增加1.06和0.64个QALY，每位患者的额外成本分别为23,208欧元和7254欧元。相应的增量成本效益比（ICER）分别为每QALY 21,823欧元和11,344欧元。间接治疗比较显示，与OClb相比，GClb的增量收益在0.44至0.77个QALY之间，每位患者的额外成本在7041欧元至5028欧元之间。ICER在每QALY 6556欧元至16,180欧元之间。敏感性分析表明结果具有稳健性。
结论
与RClb、OClb和Clb相比，GClb似乎是一种具有成本效益的治疗策略。
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