Chen Qiushi, Staton Ashley D, Ayer Turgay, Goldstein Daniel A, Koff Jean L, Flowers Christopher R
a Massachusetts General Hospital Institute for Technology Assessment , Boston , MA , USA.
b Harvard Medical School , Boston , MA , USA.
Leuk Lymphoma. 2018 Jul;59(7):1700-1709. doi: 10.1080/10428194.2017.1390230. Epub 2017 Oct 25.
Activated B-cell-like (ABC) diffuse large B-cell lymphoma (DLBCL) is associated with worse survival after standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) chemoimmunotherapy compared to germinal center B-cell-like (GCB) subtype. Preliminary evidence suggests that benefits from novel agents may vary by subtype. Hypothesizing that treatment stratified by DLBCL subtype could be potentially cost-effective, we developed micro-simulation models to compare three first-line treatment strategies: (1) standard RCHOP for all patients (2) subtype testing followed by RCHOP for GCB and novel treatment for ABC DLBCL, and (3) novel treatment for all patients. Based on phase 2 evidence, we used lenalidomide + RCHOP as a surrogate novel treatment. The subtype-based approach showed a favorable incremental cost-effectiveness ratio of $15,015/quality-adjusted life year compared with RCHOP. Although our exploratory analyses demonstrated a wide range of conditions where subtype-based treatment remained cost-effective, data from phase 3 trials are needed to validate our models' findings and draw definitive conclusions.
与生发中心B细胞样（GCB）亚型相比，活化B细胞样（ABC）弥漫性大B细胞淋巴瘤（DLBCL）在接受标准利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松（RCHOP）化疗免疫治疗后的生存率更低。初步证据表明，新型药物的疗效可能因亚型而异。假设根据DLBCL亚型进行分层治疗可能具有潜在的成本效益，我们开发了微观模拟模型，以比较三种一线治疗策略：（1）所有患者均采用标准RCHOP治疗；（2）先进行亚型检测，GCB患者采用RCHOP治疗，ABC DLBCL患者采用新型治疗；（3）所有患者均采用新型治疗。基于2期证据，我们使用来那度胺+RCHOP作为替代新型治疗方法。与RCHOP相比，基于亚型的治疗方法显示出良好的增量成本效益比，为15,015美元/质量调整生命年。尽管我们的探索性分析表明，在多种情况下基于亚型的治疗仍具有成本效益，但仍需要3期试验的数据来验证我们模型的结果并得出明确结论。
