Matasar Matthew, Masaquel Anthony, S Ho Rodrigo, Launonen Aino, Ng Carmen D, Wang Rongrong, Fox David, Hossain Farah, Li Jia, Burke John M
Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Genentech, Inc, South San Francisco, CA, USA.
J Med Econ. 2023 Jan-Dec;26(1):1134-1144. doi: 10.1080/13696998.2023.2254640.
We evaluated the pharmacoeconomic value of polatuzumab vedotin plus rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) in previously untreated diffuse large B-cell lymphoma (DLBCL) versus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
A 3-state partitioned survival model was used to estimate life years (LYs), quality-adjusted LYs (QALYs), and cost impacts of Pola-R-CHP versus R-CHOP. Analyses utilized mixture-cure survival modelling, assessed a lifetime horizon, discounted all outcomes at 3% per year, and examined both payer and societal perspectives. Progression-free survival, overall survival (OS), drug utilization, treatment duration, adverse reactions, and subsequent treatment inputs were based on data from the POLARIX study (NCT03274492). Costs included drug acquisition/administration, adverse reaction management, routine care, subsequent treatments, end-of-life care, and work productivity.
Incremental cost-effectiveness ratios of Pola-R-CHP versus R-CHOP were $70,719/QALY gained and $88,855/QALY gained from societal and payer perspectives, respectively. The $32,824 higher total cost of Pola-R-CHP versus R-CHOP was largely due to higher drug costs ($122,525 vs $27,694), with cost offsets including subsequent treatment (-$52,765), routine care (-$1,781), end-of-life care (-$383), and work productivity (-$8,418). Pola-R-CHP resulted in an increase of 0.47 LYs and 0.46 QALYs versus R-CHOP. Pola-R-CHP was cost-effective in 60.9% and 58.0% of simulations at a willingness-to-pay threshold of $150,000/QALY gained from societal and payer perspectives, respectively.
There was uncertainty around the OS extrapolation in the model, and costs were derived from different sources. Recommended prophylactic medications were not included; prophylactic use of granulocyte colony-stimulating factor for all patients was assumed to be equal across treatment arms in POLARIX. Work productivity loss was estimated from a general population and was not specific to patients with DLBCL.
Pola-R-CHP was projected to be cost-effective versus R-CHOP in previously untreated DLBCL, suggesting that Pola-R-CHP represents good value relative to R-CHOP in this setting.
我们评估了泊洛妥珠单抗维达汀联合利妥昔单抗、环磷酰胺、多柔比星和泼尼松（Pola-R-CHP）与利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）相比，在先前未治疗的弥漫性大B细胞淋巴瘤（DLBCL）中的药物经济学价值。
采用三状态分区生存模型来估计Pola-R-CHP与R-CHOP相比的生命年（LYs）、质量调整生命年（QALYs）和成本影响。分析采用混合治愈生存模型，评估终身视野，每年以3%的贴现率对所有结果进行贴现，并从支付方和社会角度进行考察。无进展生存期、总生存期（OS）、药物利用、治疗持续时间、不良反应和后续治疗投入均基于POLARIX研究（NCT03274492）的数据。成本包括药物采购/给药、不良反应管理、常规护理、后续治疗、临终关怀和工作生产力。
从社会和支付方角度来看，Pola-R-CHP与R-CHOP相比的增量成本效果比分别为每获得一个QALY增加70,719美元和88,855美元。Pola-R-CHP比R-CHOP的总成本高出32,824美元，这在很大程度上是由于药物成本较高（122,525美元对27,694美元），成本抵消包括后续治疗（-52,765美元）、常规护理（-1,781美元）、临终关怀（-383美元）和工作生产力（-8,418美元）。与R-CHOP相比，Pola-R-CHP导致LYs增加0.47，QALYs增加0.46。从社会和支付方角度来看，在每获得一个QALY支付意愿阈值为150,000美元的情况下，Pola-R-CHP在60.9%和58.0%的模拟中具有成本效益。
模型中OS外推存在不确定性，成本来自不同来源。未包括推荐的预防性药物；在POLARIX研究中，假设所有患者预防性使用粒细胞集落刺激因子在各治疗组中是相等的。工作生产力损失是根据一般人群估计的，并非特定于DLBCL患者。
在先前未治疗的DLBCL中，预计Pola-R-CHP与R-CHOP相比具有成本效益，这表明在这种情况下，Pola-R-CHP相对于R-CHOP具有良好的价值。
