决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Value of information analyses for advanced cell therapies: a systematic review.
信息价值分析将有助于决策者、分析人员和制造商了解,为减少先进细胞疗法上市时的决策不确定性,长期数据收集是否值得。当前估计表明,进一步研究的价值可能较低。如果未来先进细胞疗法的定价使其相应的增量成本效果比与相关成本效果阈值一致,并且其适应症针对更大的受益人群,那么收集额外数据的价值可能会增加。
先进细胞疗法在上市时往往面临高度的参数不确定性,促使人们呼吁收集更多关于长期有效性和安全性的数据。然而,收集这些数据以支持资源分配决策的价值尚不清楚。因此,本研究旨在评估所有已发表的针对先进细胞疗法的信息价值分析。
一项系统综述(PROSPERO:CRD42023446874)识别了从建库至2025年5月14日期间针对晚期细胞疗法的信息价值分析(数据库:Medline;Embase)。纳入的研究报告了完美信息期望价值(EVPI)、部分完美信息期望价值(EVPPI)、样本信息期望价值(EVSI)或抽样期望净收益(ENBS)。研究设计和信息价值结果以叙述性综合进行总结。报告质量采用卫生经济评价报告标准联合信息价值(CHEERS-VOI)清单进行评估。
共识别出三项已发表的信息价值分析:tisagenlecleucel用于复发/难治性急性淋巴细胞白血病;tisagenlecleucel用于复发/难治性弥漫性大B细胞淋巴瘤;以及TIL(肿瘤浸润淋巴细胞)细胞疗法用于晚期黑色素瘤。受益人群分别为每年6例、36例和400例。所有研究均报告了EVPI;两项研究报告了EVPPI。估计的基准情形人群EVPI分别为:€314,455、€0和€2,250,000。估计的EVPPI表明,生存外推的输入参数是进一步研究中最有价值的目标,特别是在探索较低治疗获得成本的情景分析中。
BACKGROUND: Advanced cell therapies often face high parameter uncertainty at launch, prompting calls to collect further data about long-term effectiveness and safety. However, the value of collecting these data to support resource allocation decision-making is not known. Therefore, this study aimed to appraise all published value of information analyses for advanced cell therapies. METHODS: A systematic review (PROSPERO: CRD42023446874) identified value of information analyses for advanced cell therapies between inception and 14 May 2025 (databases: Medline; Embase). Included studies reported the expected value of perfect information (EVPI), expected value of partial perfect information (EVPPI), expected value of sample information (EVSI) or expected net benefit of sampling (ENBS). Study design and value of information results were summarised in a narrative synthesis. Quality of reporting was assessed using the Consolidated Health Economic Evaluation Reporting Standards Value of Information (CHEERS-VOI) checklist. RESULTS: Three published value of information analyses were identified: tisagenlecleucel for relapsed/refractory acute lymphoblastic leukemia; tisagenlecleucel for relapsed/refractory diffuse large B-cell lymphoma, and tumor infiltrating lymphocyte cell therapy for advanced melanoma. The beneficiary populations were 6, 36, and 400 individuals per year, respectively. All studies reported EVPI; two studies reported EVPPI. Estimated base case population EVPI was: €314,455, €0, and €2,250,000, respectively. Estimated EVPPI indicated that input parameters for survival extrapolations were the most valuable targets for further research specifically during scenario analyses that explored a lower cost of treatment acquisition. CONCLUSIONS: Value of information analyses will help decision-makers, analysts, and manufacturers understand whether long-term data collection is worthwhile to reduce decision uncertainty for advanced cell therapies at launch. Current estimates indicated that the value of further research is likely to be low. The value of collecting additional data will likely increase if future advanced cell therapies are priced such that their corresponding incremental cost-effectiveness ratio aligns with a relevant cost-effectiveness threshold and if they are indicated for larger beneficiary populations.
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