Tobin Joshua W D, Crothers Anna, Ma Ti Eric, Mollee Peter, Gandhi Maher K, Scuffham Paul, Hapgood Greg
Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
Leuk Lymphoma. 2021 Dec;62(14):3484-3492. doi: 10.1080/10428194.2021.1957866. Epub 2021 Jul 29.
Recent data suggest the use of radiotherapy alone (RT) in Early-Stage Follicular Lymphoma is declining. Cost-effectiveness analysis of treatments has not been performed. We constructed a partitioning model (15-year horizon) to compare RT, combined-modality therapy (CMT) and immunochemotherapy with rituximab maintenance (ICT + RM) from a PET-staged cohort from the Australian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. AUD $75,000 was defined as the willingness-to-pay threshold (WTP). The direct healthcare costs were: RT $12,791, CMT $29,391 and ICT + RM $42,644. Compared with RT, CMT demonstrated minimal improvement in QALYs (+0.01) and an ICER well above the WTP threshold ($1,535,488). Compared with RT, ICT + RM demonstrated an improvement in QALYs (+0.41) with an ICER of $73,319. Modeling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions with ICT + RM ($52,476). ICT + RM is cost-effective in early-stage FL from the Australian taxpayer perspective.
近期数据显示，早期滤泡性淋巴瘤单纯放疗（RT）的使用正在减少。尚未对治疗方法进行成本效益分析。我们构建了一个分区模型（15年展望期），以比较来自澳大利亚淋巴瘤联盟PET分期队列中的放疗、综合治疗（CMT）以及利妥昔单抗维持免疫化疗（ICT + RM）。计算了终身直接医疗保健成本、质量调整生命年（QALY）和增量成本效益比（ICER）。将75,000澳元定义为支付意愿阈值（WTP）。直接医疗保健成本分别为：放疗12,791澳元、CMT 29,391澳元和ICT + RM 42,644澳元。与放疗相比，CMT在QALY方面改善甚微（+0.01），ICER远高于WTP阈值（1,535,488澳元）。与放疗相比，ICT + RM在QALY方面有所改善（+0.41），ICER为73,319澳元。使用利妥昔单抗生物类似药模拟成本降低25%，导致ICT + RM的ICER进一步降低（52,476澳元）。从澳大利亚纳税人的角度来看，ICT + RM在早期滤泡性淋巴瘤中具有成本效益。
