背景:发热性中性粒细胞减少症(FN)在接受骨髓抑制化疗的淋巴瘤患者中是一种普遍且可能危及生命的并发症。Pegfilgrastim比非格司亭更有效地预防FN。然而,由于其成本较高,其使用受到限制。Pegfilgrastim的金钱价值尚不清楚。
目的:系统评价与非格司亭相比,在淋巴瘤患者中,培格司亭作为化疗诱导的FN的一级或二级预防的成本效益。
方法:在PubMed,EMBASE,Cochrane图书馆数据库,谷歌学者。使用最广泛的经济评价(成本效益分析,成本效用分析和成本效益分析)被纳入审查。数据提取以综合卫生经济评价报告标准清单为指导,使用JoannaBriggsInstitute(JBI)核对表评估审查文章的质量.对成本效益数据进行了严格的总结和叙述综合。费用调整为2020美元。
结果:我们确定了八项经济评估研究(两项成本效用分析,三项成本效益分析,和三项报告成本效益和成本效用分析的研究)。这些研究中有一半来自欧洲(n=4),另一半来自伊朗,美国,加拿大,和新加坡。6项研究符合>80%的JBI质量评估标准。这些研究中的大多数(n=6)的成本效益估计是针对接受具有高FN风险(>20%)的骨髓抑制化疗的非霍奇金淋巴瘤患者。研究考虑了广泛的基线FN风险(17-97.4%)和死亡率(5.8-8.9%)。报告的增量成本效益比率在每质量调整生命年(QALY)2199美元至8,871,600美元之间,占主导地位,避免了每FN44,358美元,每生命年增加4261美元-7251美元。最有影响的参数是药物和住院费用,FN的相对风险,和死亡率福利的假设。
结论:大多数研究表明,与非格司亭相比,在淋巴瘤患者中,pegfilgrastim作为化疗诱导的FN的一级和二级预防具有成本效益,成本效益阈值为每QALY50,000美元。这些发现可以帮助临床医生和医疗保健决策者在与研究相似的环境中就化疗诱导的FN的资源分配做出明智的决定。
BACKGROUND: Febrile neutropenia (FN) is a prevalent and potentially life-threatening complication in patients with lymphoma receiving myelosuppressive chemotherapy. Pegfilgrastim is more effective than
filgrastim as prophylaxis for FN. However, its usage has been limited because of its higher cost. Pegfilgrastim\'s value for money remains unclear.
OBJECTIVE: To systematically
review the cost-effectiveness of pegfilgrastim compared to
filgrastim as a primary or secondary prophylaxis for chemotherapy-induced FN among patients with lymphoma.
METHODS: A systematic literature search was conducted in PubMed, EMBASE, Cochrane Library databases, and Google Scholar. The most widely used economic evaluations (cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis) were included in the
review. Data extraction was guided by the Consolidated Health Economic Evaluation Reporting Standards checklist, and the quality of reviewed articles was assessed using the Joanna Briggs Institute (JBI) checklist. Cost-effectiveness data were rigorously summarized and synthesized narratively. Costs were adjusted to US$ 2020.
RESULTS: We identified eight economic evaluation studies (two cost-utility analyses, three cost-effectiveness analyses, and three studies reporting both cost-effectiveness and cost-utility analyses). Half of these studies were from Europe (n = 4), the other half were from Iran, USA, Canada, and Singapore. Six studies met > 80% of the JBI quality assessment criteria. Cost-effectiveness estimates in the majority (n = 6) of these studies were for Non-Hodgkin Lymphoma patients receiving myelosuppressive chemotherapy with high-risk of FN (> 20%). The studies considered a wide range of baseline FN risk (17-97.4%) and mortality rates (5.8-8.9%). Reported incremental cost-effectiveness ratios ranged from US$ 2199 to US$ 8,871,600 per quality-adjusted life-year (QALY) gained, dominant to US$ 44,358 per FN averted, and US$ 4261- US$ 7251 per life-years gained. The most influential parameters were medication and hospitalization costs, the relative risk of FN, and assumptions of mortality benefit.
CONCLUSIONS: Most studies showed that pegfilgrastim is cost-effective compared to
filgrastim as primary and secondary prophylaxis for chemotherapy-induced FN among patients with lymphoma at a cost-effectiveness threshold of US$ 50,000 per QALY gained. The findings could assist clinicians and healthcare decision-makers to make informed decisions regarding resource allocation for the management of chemotherapy-induced FN in settings similar to those studied.