移植不合格的复发或难治性弥漫性大 B 细胞淋巴瘤治疗方案的成本效益分析——效率前沿方法的经验。
Cost-effectiveness analysis of transplant-ineligible relapsed or refractory diffuse large B-cell lymphoma treatment options-Experience of the efficiency frontier approach.
机构信息
Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
VITIS Healthcare Group, Cologne, Germany.
出版信息
Eur J Haematol. 2023 Dec;111(6):895-908. doi: 10.1111/ejh.14095. Epub 2023 Aug 29.
OBJECTIVES
The treatment of relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) changed remarkably since the European Medicines Agency-approved chimeric antigen receptor T-cell (CAR-T) therapies (axicabtagene ciloleucel [axi-cel], lisocabtagene maraleucel [liso-cel], tisagenlecleucel [tisa-cel]) for the third-line onwards (3+L), and targeted therapies (polatuzumab vedotin-bendamustine-rituximab [pola-BR], tafasitamab-lenalidomide [Tafa-L]) for the second-line (2L) onwards. As associated rising treatment costs represent an economic burden, the cost-effectiveness of transplant-ineligible R/R DLBCL interventions was assessed from a German healthcare payer's perspective, using the efficiency frontier (EF) approach.
METHODS
A systematic literature review was performed to determine the clinical benefit concerning median overall survival (OS) of bendamustine-rituximab (BR), rituximab-gemcitabine-oxaliplatin (R-GemOx), axi-cel, liso-cel, tisa-cel, pola-BR, and Tafa-L. First-year treatment costs (drug and medical services costs) were calculated. Results were merged on two-dimensional graphs illustrating 2L and 3+L EFs.
RESULTS
Second-line EF is formed by BR (median OS 11.49 months, €23 958) and Tafa-L (45.7, €104 541), 3+L EF is formed by R-GemOx (12.0, €29 080), Tafa-L (15.5, €104 541), and axi-cel (18.69, €308 516). These interventions build the respective cost-effectiveness thresholds for novel interventions.
CONCLUSIONS
Using the EF approach, the currently most cost-effective interventions (based on cost-effectiveness ratios) in the indication of R/R DLBCL were identified to guide international reimbursement decisions.
目的
自欧洲药品管理局批准嵌合抗原受体 T 细胞（CAR-T）疗法（axicabtagene ciloleucel [axi-cel]、lisocabtagene maraleucel [liso-cel]、tisagenlecleucel [tisa-cel]）用于三线及以上（3+L），以及靶向治疗（polatuzumab vedotin-bendamustine-rituximab [pola-BR]、tafasilumab-lenalidomide [Tafa-L]）用于二线及以上（2L）以来，复发/难治性（R/R）弥漫性大 B 细胞淋巴瘤（DLBCL）的治疗发生了显著变化。由于相关治疗费用的增加代表了经济负担，因此从德国医疗保健支付者的角度，使用效率前沿（EF）方法评估了不适合移植的 R/R DLBCL 干预措施的成本效益。
方法
进行了系统的文献回顾，以确定苯达莫司汀-利妥昔单抗（BR）、利妥昔单抗-吉西他滨-奥沙利铂（R-GemOx）、axi-cel、liso-cel、tisa-cel、pola-BR 和 Tafa-L 对中位总生存期（OS）的临床获益。计算了第一年的治疗成本（药物和医疗服务成本）。结果在二维图上合并，显示了 2L 和 3+L 的 EF。
结果
二线 EF 由 BR（中位 OS 11.49 个月，€23958）和 Tafa-L（45.7，€104541）组成，3+L EF 由 R-GemOx（12.0，€29080）、Tafa-L（15.5，€104541）和 axi-cel（18.69，€308516）组成。这些干预措施为新的干预措施建立了各自的成本效益阈值。
结论
使用 EF 方法，确定了 R/R DLBCL 适应证中目前最具成本效益的干预措施（基于成本效益比），以指导国际报销决策。
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