化疗与利妥昔单抗联用治疗非霍奇金淋巴瘤的药物经济学系统评价_《中国循证医学杂志》

作者：

 孙艳坤 ¹ , 刘国恩 ² , 李幼平 ³

1. 北京大学中国卫生经济研究中心（北京 100871）；2. 北京大学光华管理学院，中国卫生经济研究中心（北京 100871）；3. 四川大学华西医院中国循证医学中心（成都 610041）;

关键词：

药物经济学评价非霍奇金淋巴瘤利妥昔单抗系统评价

DOI：

10.7507/1672-2531.20130125

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价传统化疗与利妥昔单抗联用治疗非霍奇金淋巴瘤（NHL）的药物经济学价值。
方法　计算机检索PubMed、ScienceDirect、Health Technology Assessment（HTA）和Cochrane系统评价数据库（CDSR）1998～2012年间公开发表的利妥昔单抗治疗NHL的药物经济学文献，并辅以文献追溯和手工检索等方法。根据事先确定的纳入与排除标准筛选文献，再按照Papaioannou HTA报告中的评价表格，系统评价利妥昔单抗与传统化疗联用与单纯化疗比较的增量成本效果（ICER）。
结果　利妥昔单抗治疗的ICER的均值英国为16 318美元/QALY，欧洲大陆国家为17 688美元/QALY，美国为22 461美元/QALY。参照相应各国的意愿支付阀值，所有纳入文献的ICER比值均在其各国的意愿支付范围内。
结论　根据现有国外文献，对于NHL，传统化疗与利妥昔单抗联用的综合治疗方案的ICER比值均在各国意愿支付阈值范围内，是更具成本-效果优势的治疗方案。

引用本文： 孙艳坤,刘国恩,李幼平. 化疗与利妥昔单抗联用治疗非霍奇金淋巴瘤的药物经济学系统评价. 中国循证医学杂志, 2013, 13(6): 700-708. doi: 10.7507/1672-2531.20130125 复制

1.	Timothy C. non-Hodgkin’s lymphoma. Cancer, 1995, 1(suppl): 370.
2.	Marky I, Schmiegelow K, Perkkio M, et al. Childhood non-Hodgkin’s lymphoma in the five Nordic countries. J pediatr Hematol Oncol, 1995, 17(2): 163.
3.	孙曾一. 恶性淋巴瘤的流行病学. 实用肿瘤学杂志, 1989, 4(4).
4.	董国贤, 姚文庆, 黎均耀. 沈阳地区恶性淋巴瘤发病因素的研究. 实用肿瘤学杂志, 1988, 2(4): 268.
5.	中华医学会血液学分会. 中国弥漫大B细胞诊断与治疗指南. 2011.
6.	中华医学会血液学分会. 中国滤泡性淋巴瘤诊断与治疗指南. 2011.
7.	Gross S A, Zhu X Z, Bao L, et al. A prospective study of 728 cases of non-Hodgkin lymphoma from a single laboratory in Shanghai, China. Int J Hematol, 2008, 88(22): 165-173.
8.	李旸, 刘卓刚, 郝良纯, 等. 中国非霍奇金淋巴瘤患者行利妥昔单抗联合CHOP方案化疗疗效与安全性的 Meta分析. 循证医学, 2011, 11(2): 112-116.
9.	石浩强, 沈阳, 叶莹琼, 等. 利妥昔单抗对于非霍奇金淋巴瘤的治疗及其药物经济学. 药学服务与研究, 2007, 7(5): 332-334.
10.	Papaioannou D, Rafia R, Rathbone J, et al. Rituximab for the first-line treatment of stage III-IV follicular lymphoma a systematic review and economic evaluation. 2012.
11.	Best JH, Hornberger J, Proctor SJ, et al. Cost-effectiveness analysis of rituximab combined with chop for treatment of diffuse large B-cell lymphoma. Value Health, 2005, 8(4): 462-470.
12.	Bagust A, Boland A, Hockenhull J, et al. Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2009, 13 Suppl 2: 41-48.
13.	Deconinck E, Miadi-Fargier H, Pen CL, et al.Cost effectiveness of rituximab maintenance therapy in follicular lymphoma: long-term economic evaluation. Pharmacoeconomics, 2010, 28(1): 35-46.
14.	Hayslip JW, Simpson KN. Cost-effectiveness of extended adjuvant rituximab for US patients aged 65-70 years with follicular lymphoma in second remission. Clin Lymphoma Myeloma, 2008, 8(3): 166-170.
15.	Kasteng F, Erlanson M, Hagberg H, et al. Cost-effectiveness of maintenance rituximab treatment after second line therapy in patients with follicular lymphoma in Sweden. Acta Oncol, 2008, 47(6): 1029-1036.
16.	Dundar Y, Bagust A, Hounsome J, et al. Rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2009, 13 Suppl 1: 23-28.
17.	Ferrara F, Ravasio R. Cost-effectiveness analysis of the addition of rituximab to CHOP in young patients with good-prognosis diffuse large-B-cell lymphoma. Clin Drug Investig, 2008, 28(1): 55-65.
18.	Hornberger JC, Best JH. Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma. Cancer, 2005, 103(8): 1644-1651.
19.	Hornberger J, Reyes C, Lubeck D, et al. Economic evaluation of rituximab plus cyclophosphamide, vincristine and prednisolone for advanced follicular lymphoma. Leuk Lymphoma, 2008, 49(2): 227-236.
20.	Knight C, Hind D, Brewer N, et al. Rituximab (MabThera) for aggressive non-Hodgkin’s lymphoma: systematic review and economic evaluation. Health Technol Assess, 2004, 8(37): 1-82.
21.	Ray J, Carr E, Lewis G, et al. An evaluation of the cost-effectiveness of rituximab in combination with chemotherapy for the first-line treatment of follicular non-Hodgkin’s lymphoma in the UK. Value Health, 2010, 13(4): 346-357.
22.	Grupo de Farmacoeconomía del Linfoma Folicular. [Rituximab cost analysis for maintenance treatment of patients with follicular lymphoma]. [Article in Spanish]. Farm Hosp, 2008, 32(1): 25-34.
23.	Soini EJ, Martikainen JA, nousiainen T. Treatment of follicular non-Hodgkin’s lymphoma with or without rituximab: cost-effectiveness and value of information based on a 5-year follow-up. Ann Oncol, 2011, 22(5): 1189-1197.
24.	Bagust A, Boland A, Blundell M, et al. Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2010.
25.	Groot MT, Lugtenburg PJ, Hornberger J, et al. Cost-effectiveness of rituximab (MabThera) in diffuse large B-cell lymphoma in The Netherlands. Eur J Haematol, 2005, 74(3): 194-202.
26.	Van Oers MH, Klasa R, Marcus RE, et al. Rituximab maintenance improves clinical outcomes of relapsed/resistant follicular non-Hodgkin’s lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood, 2006, 108: 3295-3301.
27.	Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med, 2002, 346: 235–242.
28.	Marcus R, Imrie K, Belch A, et al. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood, 2005, 105: 1417-1423.
29.	Pfreundschuh M, Trumper L, Osterborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol, 2006, 7: 379-391.
30.	Marcus R, Imrie K, Solal-Celigny P, et al. Phase III study of R-CVP compared with cyclophosphamide vincristine prednisone alone in patients with previously untreated advanced follicular lymphoma. J Clin Oncol, 2008, 26: 4579-4586.
31.	Hiddemann W, Kneba M, Dreyling M, et al. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low Grade Lymphoma Study Group. Blood, 2005, 106: 3725-3732.
32.	Herold M, Haas A, Srock S, et al. Rituximab added to first-line mitoxantrone, chlorambucil, and prednisolone chemotherapy followed by interferon maintenance prolongs survival in patients with advanced follicular lymphoma: an East German Study Group Hematology and Oncology Study. J Clin Oncol, 2007, 25(15): 1986-1992.
33.	Salles G, Mounier N, de Guibert S, et al. Rituximab combined with chemotherapy and interferon in follicular lymphoma patients: results of the GELA-GOELAMSFL2000 study. Blood, 2008, 112: 4824-4831.

1. Timothy C. non-Hodgkin’s lymphoma. Cancer, 1995, 1(suppl): 370.
2. Marky I, Schmiegelow K, Perkkio M, et al. Childhood non-Hodgkin’s lymphoma in the five Nordic countries. J pediatr Hematol Oncol, 1995, 17(2): 163.
3. 孙曾一. 恶性淋巴瘤的流行病学. 实用肿瘤学杂志, 1989, 4(4).
4. 董国贤, 姚文庆, 黎均耀. 沈阳地区恶性淋巴瘤发病因素的研究. 实用肿瘤学杂志, 1988, 2(4): 268.
5. 中华医学会血液学分会. 中国弥漫大B细胞诊断与治疗指南. 2011.
6. 中华医学会血液学分会. 中国滤泡性淋巴瘤诊断与治疗指南. 2011.
7. Gross S A, Zhu X Z, Bao L, et al. A prospective study of 728 cases of non-Hodgkin lymphoma from a single laboratory in Shanghai, China. Int J Hematol, 2008, 88(22): 165-173.
8. 李旸, 刘卓刚, 郝良纯, 等. 中国非霍奇金淋巴瘤患者行利妥昔单抗联合CHOP方案化疗疗效与安全性的 Meta分析. 循证医学, 2011, 11(2): 112-116.
9. 石浩强, 沈阳, 叶莹琼, 等. 利妥昔单抗对于非霍奇金淋巴瘤的治疗及其药物经济学. 药学服务与研究, 2007, 7(5): 332-334.
10. Papaioannou D, Rafia R, Rathbone J, et al. Rituximab for the first-line treatment of stage III-IV follicular lymphoma a systematic review and economic evaluation. 2012.
11. Best JH, Hornberger J, Proctor SJ, et al. Cost-effectiveness analysis of rituximab combined with chop for treatment of diffuse large B-cell lymphoma. Value Health, 2005, 8(4): 462-470.
12. Bagust A, Boland A, Hockenhull J, et al. Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2009, 13 Suppl 2: 41-48.
13. Deconinck E, Miadi-Fargier H, Pen CL, et al.Cost effectiveness of rituximab maintenance therapy in follicular lymphoma: long-term economic evaluation. Pharmacoeconomics, 2010, 28(1): 35-46.
14. Hayslip JW, Simpson KN. Cost-effectiveness of extended adjuvant rituximab for US patients aged 65-70 years with follicular lymphoma in second remission. Clin Lymphoma Myeloma, 2008, 8(3): 166-170.
15. Kasteng F, Erlanson M, Hagberg H, et al. Cost-effectiveness of maintenance rituximab treatment after second line therapy in patients with follicular lymphoma in Sweden. Acta Oncol, 2008, 47(6): 1029-1036.
16. Dundar Y, Bagust A, Hounsome J, et al. Rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2009, 13 Suppl 1: 23-28.
17. Ferrara F, Ravasio R. Cost-effectiveness analysis of the addition of rituximab to CHOP in young patients with good-prognosis diffuse large-B-cell lymphoma. Clin Drug Investig, 2008, 28(1): 55-65.
18. Hornberger JC, Best JH. Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma. Cancer, 2005, 103(8): 1644-1651.
19. Hornberger J, Reyes C, Lubeck D, et al. Economic evaluation of rituximab plus cyclophosphamide, vincristine and prednisolone for advanced follicular lymphoma. Leuk Lymphoma, 2008, 49(2): 227-236.
20. Knight C, Hind D, Brewer N, et al. Rituximab (MabThera) for aggressive non-Hodgkin’s lymphoma: systematic review and economic evaluation. Health Technol Assess, 2004, 8(37): 1-82.
21. Ray J, Carr E, Lewis G, et al. An evaluation of the cost-effectiveness of rituximab in combination with chemotherapy for the first-line treatment of follicular non-Hodgkin’s lymphoma in the UK. Value Health, 2010, 13(4): 346-357.
22. Grupo de Farmacoeconomía del Linfoma Folicular. [Rituximab cost analysis for maintenance treatment of patients with follicular lymphoma]. [Article in Spanish]. Farm Hosp, 2008, 32(1): 25-34.
23. Soini EJ, Martikainen JA, nousiainen T. Treatment of follicular non-Hodgkin’s lymphoma with or without rituximab: cost-effectiveness and value of information based on a 5-year follow-up. Ann Oncol, 2011, 22(5): 1189-1197.
24. Bagust A, Boland A, Blundell M, et al. Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2010.
25. Groot MT, Lugtenburg PJ, Hornberger J, et al. Cost-effectiveness of rituximab (MabThera) in diffuse large B-cell lymphoma in The Netherlands. Eur J Haematol, 2005, 74(3): 194-202.
26. Van Oers MH, Klasa R, Marcus RE, et al. Rituximab maintenance improves clinical outcomes of relapsed/resistant follicular non-Hodgkin’s lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood, 2006, 108: 3295-3301.
27. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med, 2002, 346: 235–242.
28. Marcus R, Imrie K, Belch A, et al. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood, 2005, 105: 1417-1423.
29. Pfreundschuh M, Trumper L, Osterborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol, 2006, 7: 379-391.
30. Marcus R, Imrie K, Solal-Celigny P, et al. Phase III study of R-CVP compared with cyclophosphamide vincristine prednisone alone in patients with previously untreated advanced follicular lymphoma. J Clin Oncol, 2008, 26: 4579-4586.
31. Hiddemann W, Kneba M, Dreyling M, et al. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low Grade Lymphoma Study Group. Blood, 2005, 106: 3725-3732.
32. Herold M, Haas A, Srock S, et al. Rituximab added to first-line mitoxantrone, chlorambucil, and prednisolone chemotherapy followed by interferon maintenance prolongs survival in patients with advanced follicular lymphoma: an East German Study Group Hematology and Oncology Study. J Clin Oncol, 2007, 25(15): 1986-1992.
33. Salles G, Mounier N, de Guibert S, et al. Rituximab combined with chemotherapy and interferon in follicular lymphoma patients: results of the GELA-GOELAMSFL2000 study. Blood, 2008, 112: 4824-4831.

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化疗与利妥昔单抗联用治疗非霍奇金淋巴瘤的药物经济学系统评价

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《中国循证医学杂志》

化疗与利妥昔单抗联用治疗非霍奇金淋巴瘤的药物经济学系统评价

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