爱尔兰医疗环境下 tisagenlecleucel 治疗复发/难治性弥漫大 B 细胞淋巴瘤的成本效用与信息价值分析

The evidence base of tisagenlecleucel is uncertain.

To evaluate the cost-effectiveness of tisagenlecleucel. To conduct expected value of perfect information (EVPI) and partial EVPI (EVPPI) analyses. STUDY DESIGN: A three-state partitioned survival model. A short-term decision tree partitioned patients in the tisagenlecleucel arm according to infusion status. Survival was extrapolated to 5 years; general population mortality with a standardised mortality ratio was then applied. EVPI and EVPPI were scaled up to population according to the incidence of the decision. SETTING: Irish healthcare payer. PARTICIPANTS: Patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). INTERVENTIONS: Tisagenlecleucel versus Salvage Chemotherapy (with or without haematopoietic stem cell transplant). MAIN OUTCOME MEASURE: Incremental cost-effectiveness ratio (ICER). Population EVPI and EVPPI.

At list prices, the ICER was 119,509 per quality-adjusted life year (QALY) (incremental costs 218,092; incremental QALYs 1.82). Probability of cost-effectiveness, at a 45,000 per QALY threshold, was 0%. Population EVPI was 0.00. Population EVPI, at the price of tisagenlecleucel that reduced the ICER to 45,000 per QALY, was 3,989,438. Here, survival analysis had the highest population EVPPI ( 1,128,053).

Tisagenlecleucel is not cost-effective, versus salvage chemotherapy (with or without haematopoietic stem cell transplant), for R/R DLBCL in Ireland. At list prices, further research to decrease decision uncertainty may not be of value.