Rituximab for the first-line treatment of stage III–IV follicular lymphoma (review of Technology Appraisal No. 110): a systematic review and economic evaluation.

摘要: BACKGROUND Follicular lymphoma (FL) is a non-Hodgkin's which typically presents when the disease at an advanced stage. The majority of patients receive first-line therapy rituximab in combination with chemotherapy, two-thirds receiving cyclophosphamide, vincristine and prednisolone. clinical cost-effectiveness other chemotherapies not known. OBJECTIVE To systematically evaluate appraise effectiveness (MabThera(®), Roche Products) compared chemotherapy alone, for treatment symptomatic stage III-IV FL. DATA SOURCES A systematic review literature economic evaluation were carried out. Key databases [including MEDLINE In-Process & Other Non-Indexed Citations; Cumulative Index to Nursing Allied Health Literature (CINAHL); EMBASE; Cochrane Library, including Database Systematic Reviews (CDSR), Central Register Controlled Trials (CENTRAL), Abstracts Effects (DARE), NHS Economic Evaluation (NHS EED) Technology Assessment (HTA) databases; Science Citation (SCI); BIOSIS], plus research registers conference proceedings, searched relevant studies from inception up October 2010. REVIEW METHODS One reviewer assessed titles abstracts identified by search strategy, obtained full text papers screened them against inclusion criteria. Data included extracted one using standardised data extraction form checked second reviewer. quality was second. patient-level simulation model developed estimate costs quality-adjusted life-year (QALY) gains perspective UK Personal Social Services, benefits discounted 3.5% annually. RESULTS Four randomised controlled trials comparing (R-chemotherapy) alone untreated, FL identified. R-chemotherapy increased likelihood response all four trials, no additional toxicity relevance. Overall rates significantly improved difference between arms 5% 24%, respectively. Complete also improved, 2% 25%, Exploratory meta-analyses conducted; level statistical heterogeneity very high thus we believe individual be more robust estimator efficacy specific regimens. Over follow-up period 4-5 years, overall survival rate three although two compromised owing use treatments. incremental ratio (ICER) addition CVP (cyclophosphamide, prednisolone), CHOP doxorubicin/adriamycin, prednisolone) MCP [mitoxantrone, chlorambucil (Leukeran(®), Aspen) prednisolone] £7720, £10,834 £9316 per QALY gained, respectively, it assumed that maintenance used. scenario analysis presented, assuming responders induction rituximab, increasing ICER £14,959, £21,687 £20,493 LIMITATIONS These relate sources used first line utility values; there uncertainty about effect salvage on who had been previously treated anthracycline regimen. There whether or as effective second-line have rituximab. CONCLUSIONS results showed improvement outcomes, minimal clinically adverse events toxicity. cost gained estimated < £25,000 comparisons under our base-case assumption considerably lower if assumed. More pre-treated required future work. FUNDING National Institute Research programme.