Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
BMJ Open. 2023 Mar 27;13(3):e068943. doi: 10.1136/bmjopen-2022-068943.
Rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone, once every 3 weeks (R-CHOP21) is commonly used in non-Hodgkin's lymphoma (NHL), but accompanied by pneumonia (PCP) as a fatal treatment complication. This study aims to estimate the specific effectiveness and cost-effectiveness of PCP prophylaxis in NHL undergoing R-CHOP21.
A two-part decision analytical model was developed. Prevention effects were determined by systemic review of PubMed, Embase, Cochrane Library and Web of Science from inception to December 2022. Studies reporting results of PCP prophylaxis were included. Enrolled studies were quality assessed with Newcastle-Ottawa Scale. Costs were derived from the Chinese official websites, and clinical outcomes and utilities were obtained from published literature. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses (DSA and PSA). Willingness-to-pay (WTP) threshold was set as US$31 315.23/quality-adjusted life year (QALY) (threefold the 2021 per capita Chinese gross domestic product).
Chinese healthcare system perspective.
NHL receiving R-CHOP21.
PCP prophylaxis versus no prophylaxis.
Prevention effects were pooled as relative risk (RR) with 95% CI. QALYs and incremental cost-effectiveness ratio (ICER) were calculated.
A total of four retrospective cohort studies with 1796 participants were included. PCP risk was inversely associated with prophylaxis in NHL receiving R-CHOP21 (RR 0.17; 95% CI 0.04 to 0.67; p=0.01). Compared with no prophylaxis, PCP prophylaxis would incur an additional cost of US$527.61, and 0.57 QALYs gained, which yielded an ICER of US$929.25/QALY. DSA indicated that model results were most sensitive to the risk of PCP and preventive effectiveness. In PSA, the probability that prophylaxis was cost-effective at the WTP threshold was 100%.
Prophylaxis for PCP in NHL receiving R-CHOP21 is highly effective from retrospective studies, and routine chemoprophylaxis against PCP is overwhelmingly cost-effective from Chinese healthcare system perspective. Large sample size and prospective controlled studies are warranted.
利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松，每 3 周一次（R-CHOP21）常用于非霍奇金淋巴瘤（NHL），但伴有肺炎（PCP）作为一种致命的治疗并发症。本研究旨在评估 NHL 接受 R-CHOP21 治疗时预防性使用 PCP 的具体效果和成本效益。
开发了两部分决策分析模型。通过系统回顾 PubMed、Embase、Cochrane 图书馆和 Web of Science 从成立到 2022 年 12 月，确定了预防效果。纳入了报告 PCP 预防效果的研究。使用纽卡斯尔-渥太华量表对纳入的研究进行质量评估。成本来自中国官方网站，临床结果和效用来自已发表的文献。通过确定性和概率敏感性分析（DSA 和 PSA）评估不确定性。意愿支付（WTP）阈值设定为 31315.23 美元/质量调整生命年（QALY）（是 2021 年中国人均国内生产总值的三倍）。
中国医疗保健系统视角。
接受 R-CHOP21 治疗的 NHL 患者。
PCP 预防与无预防。
预防效果以相对风险（RR）和 95%置信区间（CI）表示。计算 QALYs 和增量成本效益比（ICER）。
共纳入 4 项回顾性队列研究，共 1796 名参与者。在接受 R-CHOP21 治疗的 NHL 患者中，PCP 风险与预防呈负相关（RR 0.17；95%CI 0.04 至 0.67；p=0.01）。与无预防相比，PCP 预防会增加 527.61 美元的额外成本，并获得 0.57 个 QALY，这导致 ICER 为 929.25 美元/QALY。DSA 表明，模型结果对 PCP 的风险和预防效果最为敏感。在 PSA 中，在 WTP 阈值下预防具有成本效益的概率为 100%。
从回顾性研究来看，NHL 接受 R-CHOP21 治疗时，PCP 的预防效果非常显著，从中国医疗保健系统的角度来看，常规使用化学预防药物预防 PCP 具有极高的成本效益。需要进行更大规模的样本量和前瞻性对照研究。
