Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Center for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Value Health Reg Issues. 2023 Jul;36:10-17. doi: 10.1016/j.vhri.2023.01.011. Epub 2023 Mar 25.
This study aims to compare the strategies fludarabine, cyclophosphamide, and rituximab and fludarabine and cyclophosphamide for the treatment of chronic lymphocytic leukemia in Brazil.
A three-states clock-reset semi-Markovian model was constructed in R. The time horizon of the analysis was 15 years and monthly cycles were used. Transition probabilities were derived from the survival curves of the CLL-8 study. Other probabilities were also derived from the medical literature. Costs included in the model referred to the application of injectable drugs, prescription cost, cost of treating adverse events, and costs of supportive care. The model was evaluated by microsimulation. To determine the study result, multiple cost-effectiveness threshold values were used.
In the main analysis, an incremental cost-effectiveness ratio of 19 029.38 PPP-US dollars (USD)/quality-adjusted life-year (QALY) (41 141.52 Brazilian real/QALY) was observed. In 1.8% of the iterations, fludarabine and cyclophosphamide was considered dominant over fludarabine, cyclophosphamide, and rituximab. It can be shown that at 1 gross domestic product (GDP) per capita/QALY, 36.1% of the iterations would consider the technology cost-effective. At 2 GDP per capita/QALY, this number rises to 82.1%. At 50 000 USD/QALY, 92.8% of the iterations would suggest the technology to be cost-effective. In terms of some threshold accepted or proposed around the world, the technology would be considered cost-effective at 50 000 USD/QALY, 3 GDP per capita/QALY, and 2 GDP per capita/QALY. It would not be cost-effective at 1 GDP per capita/QALY or the opportunity costs threshold.
It can be considered that rituximab is cost-effective for the treatment of chronic lymphocytic leukemia in Brazil.
本研究旨在比较巴西使用氟达拉滨、环磷酰胺和利妥昔单抗与氟达拉滨和环磷酰胺治疗慢性淋巴细胞白血病的策略。
在 R 语言中构建了一个三状态时钟重置半马尔可夫模型。分析的时间范围为 15 年，采用月度周期。转移概率来自 CLL-8 研究的生存曲线。其他概率也来自医学文献。模型中包含的成本涉及注射用药物的应用、处方成本、治疗不良反应的成本以及支持性护理的成本。该模型通过微模拟进行评估。为了确定研究结果，使用了多个成本效益阈值。
在主要分析中，观察到增量成本效益比为 19029.38 美元（PPP-US 美元）/质量调整生命年（QALY）（41141.52 巴西雷亚尔/QALY）。在 1.8%的迭代中，氟达拉滨和环磷酰胺被认为优于氟达拉滨、环磷酰胺和利妥昔单抗。可以表明，在人均国内生产总值（GDP）为 1 美元/QALY 的情况下，36.1%的迭代将认为该技术具有成本效益。在人均 GDP 为 2 美元/QALY 的情况下，这一数字上升至 82.1%。在 50000 美元/QALY 的情况下，92.8%的迭代将建议该技术具有成本效益。就全球范围内接受或提出的一些阈值而言，该技术在 50000 美元/QALY、人均 GDP 为 3 美元/QALY 和人均 GDP 为 2 美元/QALY 的情况下具有成本效益。在人均 GDP 为 1 美元/QALY 或机会成本阈值的情况下，该技术不具有成本效益。
可以认为利妥昔单抗在巴西治疗慢性淋巴细胞白血病是具有成本效益的。
