Policy Analysis Inc. (PAI), Chestnut Hill, MA, USA.
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Pharmacoeconomics. 2021 Oct;39(10):1163-1183. doi: 10.1007/s40273-021-01052-3. Epub 2021 Jul 17.
The objective of this study was to estimate the lifetime costs of patients receiving treatment for follicular lymphoma (FL) in the United States.
A Markov model was programmed in hēRo3 with a 6-month cycle length, 35-year time horizon (lifetime projection), and health states for line of treatment, response, receipt of maintenance therapy among responders, transformation to diffuse large B-cell lymphoma (DLBCL), development of second primary malignancy (SPM), and death. The model was used to estimate the expected lifetime costs of FL (in 2019 USD), including costs of drug acquisition and administration, transplant procedures, radiotherapy, adverse events, follow-up, DLBCL, SPM, end-of-life care, and indirect costs. Model inputs were based on published sources.
In the US, patients with FL receiving treatment have a life expectancy of approximately 14.5 years from initiation of treatment and expected lifetime direct and indirect costs of US$515,884. Costs of drugs for induction therapy represent the largest expenditure (US$233,174), followed by maintenance therapy costs (US$88,971) and terminal care costs (US$57,065). Despite the relatively advanced age of these patients, indirect costs (due to patient morbidity and mortality and caregiver lost work time) represent a substantial share of total costs (US$40,280). Treated FL patients spend approximately 6.9 years in the health states associated with first-line therapy. Approximately 66 and 46% continue to second- and third-line therapies, respectively. The mean (95% credible interval) of expected lifetime costs based on the probabilistic sensitivity analyses was US$559,202 (421,997-762,553).
In the US, the expected lifetime costs of care for FL patients who receive treatment is high. The results highlight the potential economic benefits that might be achieved by treatments for FL that prevent or delay disease progression.
本研究旨在估算美国滤泡性淋巴瘤（FL）患者接受治疗的终身成本。
使用 hēRo3 中的 Markov 模型，设定 6 个月的周期长度、35 年的时间范围（终生预测），以及治疗线、反应、应答者接受维持治疗、转化为弥漫性大 B 细胞淋巴瘤（DLBCL）、发生第二原发恶性肿瘤（SPM）和死亡的健康状态。该模型用于估算 FL（2019 年美元）的预期终身成本，包括药物获得和管理、移植程序、放疗、不良事件、随访、DLBCL、SPM、生命终末期护理和间接成本。模型输入基于已发表的来源。
在美国，开始治疗后的 FL 患者预期寿命约为 14.5 年，预计终身直接和间接成本为 515884 美元。诱导治疗药物成本占最大支出（233174 美元），其次是维持治疗成本（88971 美元）和终末期护理成本（57065 美元）。尽管这些患者年龄相对较大，但间接成本（由于患者发病率和死亡率以及护理人员失去工作时间）占总费用的很大一部分（40280 美元）。接受治疗的 FL 患者大约有 6.9 年处于一线治疗相关的健康状态。分别有 66%和 46%的患者继续进行二线和三线治疗。基于概率敏感性分析的预期终身成本的平均值（95%可信区间）为 559202 美元（421997-762553 美元）。
在美国，接受治疗的 FL 患者的终身护理预期成本很高。结果突出了可能通过预防或延缓疾病进展的 FL 治疗带来的潜在经济利益。
