Haematology and Hemotherapy Service, Hospital Virgen de la Salud, Toledo, Spain.
Haematology and Hemotherapy Service, Hospital Universitario Infanta Leonor, Madrid, Spain.
Eur J Haematol. 2018 Mar;100(3):264-272. doi: 10.1111/ejh.13007. Epub 2018 Jan 17.
To evaluate the incremental cost-utility ratio (ICUR) of idelalisib in combination with rituximab (IR) versus rituximab monotherapy (R) in the treatment of patients with relapsed or refractory (R/R) chronic lymphocytic leukaemia (CLL), from the Spanish National Health System (NHS) perspective.
A partitioned survival Markov model for a lifetime horizon (30 years) was developed to estimate costs (€, 2016) and quality-adjusted life years (QALY) with IR and R. Initial cohort included patients with CLL receiving a second or subsequent line (2L) of treatment with IR or R. Survival data were based on CLL clinical trial. Drug, administration, monitoring, adverse events and clinical management of CLL costs were included in the model. Costs and outcomes were discounted using a 3% annually. Deterministic and probabilistic sensitivity analyses (PSA) were performed.
Compared to R, 2L IR treatment resulted in QALY gain of 3.147 (4.965 versus 1.818). Total costs were €118 254 for IR versus €23 874 for R. ICUR was €29 990/QALY gained with IR versus R. In the PSA, IR was cost-effective in 78% of iterations using a threshold of €45 000/QALY.
IR can be considered a cost-effective treatment compared to R, in the treatment of R/R CLL patients for the Spanish NHS.
从西班牙国家卫生系统（NHS）的角度出发，评估idelalisib 联合利妥昔单抗（IR）与利妥昔单抗单药治疗（R）在复发或难治性（R/R）慢性淋巴细胞白血病（CLL）患者中的增量成本-效用比（ICUR）。
为了估计 IR 和 R 的成本（€，2016 年）和质量调整生命年（QALY），开发了一个终生（30 年）分割生存马尔可夫模型。初始队列包括接受 IR 或 R 二线（2L）治疗的 CLL 患者。生存数据基于 CLL 临床试验。模型中包括药物、管理、监测、CLL 不良事件和临床管理成本。成本和结果以每年 3%的贴现率贴现。进行了确定性和概率敏感性分析（PSA）。
与 R 相比，2L IR 治疗可获得 3.147 的 QALY 增益（4.965 比 1.818）。IR 的总费用为 118254 欧元，而 R 的费用为 23874 欧元。IR 的增量成本-效用比为每获得一个 QALY 需花费 29990 欧元。在 PSA 中，当使用 45000 欧元/QALY 的阈值时，IR 在 78%的迭代中是具有成本效益的。
对于西班牙 NHS 而言，IR 可被视为一种治疗 R/R CLL 患者的具有成本效益的治疗方法，优于 R。
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