首页|Cost-Effectiveness of Shortening Treatment Duration Based on Interim PET Outcome in Patients With Diffuse Large B-cell Lymphoma
Cost-Effectiveness of Shortening Treatment Duration Based on Interim PET Outcome in Patients With Diffuse Large B-cell Lymphoma
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NSTL
Cig Media Group, Lp
Guideline recommendations for diffuse large-B-cell lymphoma treatment are shifting from long to short treatment duration. Using a Markov model, we evaluated the cost-effectiveness of this shortening in treatment duration, separately in I-PET positive and I-PET negative patients. We showed that this shift is justified for I-PET negative patients, but not for I-PET positive patients as shortening treatment duration in these patients has harmful consequences. Background: Guideline recommendations for diffuse large-B-cell lymphoma (DLBCL) treatment are shifting from long to short treatment duration, although it is still unclear whether shortening treatment duration does not cause any harm. As interim PET (I-PET) has high negative predictive value for progression, we evaluated the cost-effectiveness of shortening treatment duration dependent on I-PET result. Materials and Methods: We developed a Markov cohort model using the PET Re-Analysis (PETRA) database to evaluate a long treatment duration (LTD) strategy, ie 8x R-CHOP or 6x R-CHOP plus 2 R, and a short treatment duration (STD) strategy, ie 6x R-CHOP. Strategies were evaluated separately in I-PET2 positive and I-PET2 negative patients. Outcomes included total costs and quality-adjusted life years (QALYs) per patient (pp) from a societal perspective. Net monetary benefit (NMB) per strategy was calculated using a willingness-to-pay threshold of euro 50,000/QALY. Robustness of model predictions was assessed in sensitivity analyses. Results: In I-PET2 positive patients, shortening treatment duration led to 50.4 additional deaths per 1000 patients. The STD strategy was less effective (-0.161 [95%CI:-0.343;0.028] QALYs pp) and less costly (- euro 2768 [95%CI: euro 8420; euro 1105] pp). Shortening treatment duration was not cost-effective (incremental NMB euro 5281). In I-PET2 negative patients, shortening treatment duration led to 5.0 additional deaths per 1000 patients and a minor difference in effective ness (-0.007 [95%CI:-0.136;0.140] QALY pp). The STD strategy was less costly (- euro 5807 [95%CI:- euro 10,724;- euro 2685] pp) and led to an incremental NMB of euro 5449, indicating that it is cost-effective to shorten treatment duration. Robustness of these findings was underpinned by deterministic and probabilistic sensitivity analyses. Conclusion: Treatment duration should not be shortened in I-PET2 positive patients whereas it is cost-effective to shorten treatment duration in I-PET2 negative patients.
Duehrsen, U.、Huettmann, A.、Schmitz, C.、Lugtenburg, P. J.、Barrington, S. F.、Mikhaeel, N. G.、Ceriani, L.、Zucca, E.、Carr, R.、Gyorke, T.、Burggraaff, C. N.、de Vet, H. C. W.、Hoekstra, O. S.、Zijlstra, J. M.、Coupe, V. M. H.、PETRA Consortium、Greuter, M. J. E.、Eertink, J. J.、Jongeneel, G.
NSTL
Cig Media Group, Lp
