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

Pharmacoeconomic Evaluation on Chemotherapy Combined with Rituximab for Non-Hodgkin's Lymphoma: A Systematic Review

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。

Objective To systematically evaluate the pharmacoeconomic vaule of chemotherapy combined with rituximab for patients with non-Hodgkin＇s lymphomas （NHL）. Methods A systematic literature search of cost-effec- tiveness studies on rituximab treating NHL published from 1998 to 2012 was carried out in following databases： PubMed, ScienceDirect, Health Technology Assessment （HTA） and Cochrane Database of Systematic Reviews （CDSR）. And the references of included studies were also retrieved manually. The studies were screened according to the pre-designed in- clusion and exclusion criteria, and the incremental cost- effectiveness ratio （ICER） in comparison between chemotherapy plus rituximab and chemotherapy alone was systematically evaluated according to the literature evaluation index system. Results The average ICER of Rituximab treating NHL was $16 318/QALY, $17 688/QALY, and $ 22 461/QALY in the UK, Mainland Europe, and US, respectively. All the reported ICERs in the included studies were below the implemented country-specific thresholds. Conclusion Based on present foreign literature, the integrated therapy of chemotherapy and rituximab for NHL is supposed to be a better cost-effective therapy with ICER below the implemented country-specif- ic thresholds.