化療與利妥昔單抗聯用治療非霍奇金淋巴瘤的藥物經濟學系統評價_《中國循證醫學雜志》

作者：

 孫艷坤 ¹ , 劉國恩 ² , 李幼平 ³

1. 北京大學中國衛生經濟研究中心（北京 100871）；2. 北京大學光華管理學院，中國衛生經濟研究中心（北京 100871）；3. 四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

藥物經濟學評價非霍奇金淋巴瘤利妥昔單抗系統評價

DOI：

10.7507/1672-2531.20130125

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目的　系統評價傳統化療與利妥昔單抗聯用治療非霍奇金淋巴瘤（NHL）的藥物經濟學價值。
方法　計算機檢索PubMed、ScienceDirect、Health Technology Assessment（HTA）和Cochrane系統評價數據庫（CDSR）1998～2012年間公開發表的利妥昔單抗治療NHL的藥物經濟學文獻，并輔以文獻追溯和手工檢索等方法。根據事先確定的納入與排除標準篩選文獻，再按照Papaioannou HTA報告中的評價表格，系統評價利妥昔單抗與傳統化療聯用與單純化療比較的增量成本效果（ICER）。
結果　利妥昔單抗治療的ICER的均值英國為16 318美元/QALY，歐洲大陸國家為17 688美元/QALY，美國為22 461美元/QALY。參照相應各國的意愿支付閥值，所有納入文獻的ICER比值均在其各國的意愿支付范圍內。
結論　根據現有國外文獻，對于NHL，傳統化療與利妥昔單抗聯用的綜合治療方案的ICER比值均在各國意愿支付閾值范圍內，是更具成本-效果優勢的治療方案。

引用本文： 孫艷坤,劉國恩,李幼平. 化療與利妥昔單抗聯用治療非霍奇金淋巴瘤的藥物經濟學系統評價. 中國循證醫學雜志, 2013, 13(6): 700-708. doi: 10.7507/1672-2531.20130125 復制

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.	孫曾一. 惡性淋巴瘤的流行病學. 實用腫瘤學雜志, 1989, 4(4).
4.	董國賢, 姚文慶, 黎均耀. 沈陽地區惡性淋巴瘤發病因素的研究. 實用腫瘤學雜志, 1988, 2(4): 268.
5.	中華醫學會血液學分會. 中國彌漫大B細胞診斷與治療指南. 2011.
6.	中華醫學會血液學分會. 中國濾泡性淋巴瘤診斷與治療指南. 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, 劉卓剛, 郝良純, 等. 中國非霍奇金淋巴瘤患者行利妥昔單抗聯合CHOP方案化療療效與安全性的 Meta分析. 循證醫學, 2011, 11(2): 112-116.
9.	石浩強, 沈陽, 葉瑩瓊, 等. 利妥昔單抗對于非霍奇金淋巴瘤的治療及其藥物經濟學. 藥學服務與研究, 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. 孫曾一. 惡性淋巴瘤的流行病學. 實用腫瘤學雜志, 1989, 4(4).
4. 董國賢, 姚文慶, 黎均耀. 沈陽地區惡性淋巴瘤發病因素的研究. 實用腫瘤學雜志, 1988, 2(4): 268.
5. 中華醫學會血液學分會. 中國彌漫大B細胞診斷與治療指南. 2011.
6. 中華醫學會血液學分會. 中國濾泡性淋巴瘤診斷與治療指南. 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, 劉卓剛, 郝良純, 等. 中國非霍奇金淋巴瘤患者行利妥昔單抗聯合CHOP方案化療療效與安全性的 Meta分析. 循證醫學, 2011, 11(2): 112-116.
9. 石浩強, 沈陽, 葉瑩瓊, 等. 利妥昔單抗對于非霍奇金淋巴瘤的治療及其藥物經濟學. 藥學服務與研究, 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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化療與利妥昔單抗聯用治療非霍奇金淋巴瘤的藥物經濟學系統評價

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《中國循證醫學雜志》

化療與利妥昔單抗聯用治療非霍奇金淋巴瘤的藥物經濟學系統評價

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