Erku Daniel, Tobin Joshua W D, Seymour John F, MacManus Michael, Scuffham Paul, Hapgood Greg
Menzies Health Institute Queensland Griffith University Gold Coast Queensland Australia.
Mater Research Institute University of Queensland Brisbane Queensland Australia.
EJHaem. 2025 Feb 12;6(1):e70002. doi: 10.1002/jha2.70002. eCollection 2025 Feb.
The TROG 99.03 trial demonstrated improved progression-free survival for patients with early-stage follicular lymphoma (FL) treated with systemic therapy using rituximab-cyclophosphamide, vincristine, prednisolone (R-CVP) after involved-field radiotherapy (RT) versus RT. As systemic therapy was associated with more acute toxicity, the possibility of long-term toxicity, and no survival benefit yet, the cost-effectiveness of RT+R-CVP is important.
We performed a cost-effectiveness analysis of RT (reference), RT+CVP, and RT+R-CVP from the TROG 99.03 trial.
We constructed a Markov model (15-year horizon) to compare treatments: RT (reference), RT+CVP and RT+R-CVP from the 150 patients in the TROG 99.03 trial. Median follow-up was 11.3 years (range: 4.4-17.8). Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Australian dollars AUD$50,000 was defined as the proposed willingness-to-pay threshold (WTP).
RT+R-CVP was associated with an improvement of 0.711 QALYs compared to RT, 0.532 QALYs compared to RT+CVP, and was the dominant strategy. The costs of adverse events or retreatment for relapses or transformation had a minimal influence on the ICERs. Sensitivity analyses resulted in ICER values below the WTP with RT+R-CVP remaining the dominant strategy.
RT+R-CVP is clearly cost-effective and was the dominant strategy in early-stage FL compared to RT or RT+CVP as it delivers superior outcomes at a lower cost from the Australian tax-payer's perspective.
The authors have confirmed clinical trial registration is not needed for this submission.
TROG 99.03试验表明，对于早期滤泡性淋巴瘤（FL）患者，在受累野放疗（RT）后采用利妥昔单抗-环磷酰胺、长春新碱、泼尼松龙（R-CVP）进行全身治疗，与单纯放疗相比，无进展生存期得到改善。由于全身治疗与更多的急性毒性、长期毒性的可能性相关，且尚未显示出生存获益，因此RT+R-CVP的成本效益很重要。
我们对TROG 99.03试验中的RT（对照）、RT+CVP和RT+R-CVP进行了成本效益分析。
我们构建了一个马尔可夫模型（15年时间范围）来比较治疗方案：TROG 99.03试验中150例患者的RT（对照）、RT+CVP和RT+R-CVP。中位随访时间为(11.3)年（范围：(4.4 - 17.8)年）。计算了终身直接医疗保健成本、质量调整生命年（QALY）和增量成本效益比（ICER）。将50000澳元定义为提议的支付意愿阈值（WTP）。
与RT相比，RT+R-CVP可使QALY提高(0.711)，与RT+CVP相比提高(0.532)，是主要策略。不良事件或复发或转化的再治疗成本对ICER的影响最小。敏感性分析得出ICER值低于WTP，RT+R-CVP仍是主要策略。
从澳大利亚纳税人的角度来看，RT+R-CVP显然具有成本效益，并且在早期FL中是主要策略，因为它以较低成本提供了更好的结果。
作者已确认本提交内容无需临床试验注册。
