Nehra Prerika, Chauhan Akashdeep Singh, Malhotra Pankaj, Kumar Lalit, Singh Ashish, Gupta Nidhi, Mehra Nikita, Mathew Anisha, Kataki Amal Chandra, Gupta Sudeep, Prinja Shankar
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Lancet Reg Health Southeast Asia. 2023 May 2;13:100201. doi: 10.1016/j.lansea.2023.100201. eCollection 2023 Jun.
Over the years, there has been introduction of newer drugs, like bendamustine and ibrutinib, for the management of chronic lymphocytic leukaemia (CLL). Though these drugs lead to better survival, they are also associated with higher cost. The existing evidence on cost effectiveness of these drugs is from high-income countries, which has limited generalisability for low-income and middle-income counties. Therefore, the present study was undertaken to assess the cost-effectiveness of three therapeutic regimens, chlorambucil plus prednisolone (CP), bendamustine plus rituximab (BR) and ibrutinib for CLL treatment in India.
A Markov model was developed for estimating lifetime costs and consequences in a hypothetical cohort of 1000 CLL patients following treatment with different therapeutic regimens. The analysis was performed based on a limited societal perspective, 3% discount rate and lifetime horizon. The clinical effectiveness of each regime in the form of progression-free survival and occurrence of adverse events were assessed from various randomised controlled trials. A structured comprehensive review of literature was undertaken for the identification of relevant trials. The data on utility values and out of pocket expenditure was obtained from primary data collected from 242 CLL patients across six large cancer hospitals in India.
As compared to the most affordable regimen comprising of CP as first-line followed by BR as second-line therapy, none of the other therapeutic regimens were cost-effective at one time per capita gross-domestic product of India. However, if the current price of either combination of BR and ibrutinib or even ibrutinib alone could be reduced by more than 80%, regimen comprising of BR as first-line therapy followed by second-line ibrutinib would become cost-effective.
At the current market prices, regimen comprising of CP as first-line followed by BR as second-line therapy is the most cost-effective strategy for CLL treatment in India.
Department of Health Research, Government of India.
多年来，已有如苯达莫司汀和伊布替尼等新型药物用于慢性淋巴细胞白血病（CLL）的治疗。尽管这些药物能提高生存率，但成本也更高。现有关于这些药物成本效益的证据来自高收入国家，对低收入和中等收入国家的普遍适用性有限。因此，本研究旨在评估三种治疗方案，即苯丁酸氮芥加泼尼松（CP）、苯达莫司汀加利妥昔单抗（BR）和伊布替尼在印度治疗CLL的成本效益。
建立了一个马尔可夫模型，用于估计1000名接受不同治疗方案的CLL患者的终身成本和后果。分析基于有限的社会视角、3%的贴现率和终身期限进行。从各种随机对照试验中评估了每种方案以无进展生存期和不良事件发生率形式表现出的临床疗效。对文献进行了结构化全面综述以识别相关试验。效用值和自付费用数据来自从印度六家大型癌症医院的242名CLL患者收集的原始数据。
与最经济实惠的一线采用CP、二线采用BR的治疗方案相比，在印度人均国内生产总值的情况下，其他治疗方案均不具有成本效益。然而，如果BR与伊布替尼联合用药或仅伊布替尼的当前价格能降低80%以上，一线采用BR、二线采用伊布替尼的治疗方案将具有成本效益。
在当前市场价格下，一线采用CP、二线采用BR的治疗方案是印度治疗CLL最具成本效益的策略。
印度政府卫生研究部
