文章：

阿基仑赛与标准疗法在西班牙复发/难治性大B细胞淋巴瘤二线治疗中的成本效益分析

Cost-Effectiveness Analysis of Axicabtagene Ciloleucel vs. Standard of Care in Second-Line Treatment for Relapsed/Refractory Large B-Cell Lymphoma in Spain

原文发布日期：22 June 2024

DOI: 10.3390/cancers16132301

类型: Article

开放获取: 是

英文摘要：

Purpose: To estimate the cost-effectiveness of axi-cel vs. salvage immunochemotherapy followed by high-dose chemotherapy and autologous stem-cell transplantation (HDT+ASCT) for responders to second-line treatment for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Methods: A partitioned survival mixture-cure model comprising three health states was used to estimate the costs, life years gained (LYG), and quality-adjusted life years (QALYs) accumulated over a lifetime horizon. Overall survival, event-free survival, and time to the next treatment with axi-cel and HDT+ASCT were derived from the ZUMA-7 study. The total costs (EUR, 2022) included drug acquisition and administration, ASCT, subsequent treatment, disease and adverse event management, and palliative care. The unitary costs were derived from local databases and the literature. A 3% discount rate was applied to the costs and outcomes. Results: Compared with HDT+ASCT, axi-cel provided higher LYG per patient (10.00 vs. 8.28 LYG/patient) and greater QALYs gained per patient (7.85 vs. 6.04 QALY/patient). The lifetime total costs were 343,581 EUR/patient with axi-cel vs. 257,994 EUR/patient with IQT+ASCT. The incremental cost-effectiveness ratio of axi-cel vs. HDT+ASCT was 49,627 EUR/LYG, and the incremental cost-utility ratio was 47,309 EUR/QALY. Sensitivity analyses confirmed the robustness of the model. Conclusion: Axi-cel is a potentially cost-effective alternative to HDT+ASCT for the treatment of R/R DLBCL in Spain.

摘要翻译： 

目的：评估阿基仑赛（axi-cel）对比挽救性免疫化疗序贯高剂量化疗联合自体干细胞移植（HDT+ASCT）作为复发/难治性大B细胞淋巴瘤（R/R LBCL）二线治疗方案的长期成本效益。方法：采用包含三种健康状态的分区生存混合治愈模型，估算终生时间范围内的累计成本、获得生命年（LYG）及质量调整生命年（QALYs）。总生存期、无事件生存期及至下次治疗时间等临床数据来源于ZUMA-7研究中阿基仑赛与HDT+ASCT的对比结果。总成本（欧元，2022年）涵盖药物购置与输注、自体干细胞移植、后续治疗、疾病与不良事件管理及姑息治疗。单位成本数据源自当地数据库及文献资料。成本与健康产出均采用3%的年贴现率。结果：与HDT+ASCT相比，阿基仑赛使每位患者获得更多生命年（10.00 vs. 8.28 LYG/患者）及更高质量调整生命年（7.85 vs. 6.04 QALY/患者）。终生总成本方面，阿基仑赛为343,581欧元/患者，HDT+ASCT为257,994欧元/患者。阿基仑赛对比HDT+ASCT的增量成本效果比为49,627欧元/LYG，增量成本效用比为47,309欧元/QALY。敏感性分析证实了模型的稳健性。结论：在西班牙治疗R/R DLBCL患者时，阿基仑赛是相较于HDT+ASCT具有潜在成本效益优势的治疗选择。

原文链接：

Cost-Effectiveness Analysis of Axicabtagene Ciloleucel vs. Standard of Care in Second-Line Treatment for Relapsed/Refractory Large B-Cell Lymphoma in Spain