臺灣晚期CD20陽性慢性淋巴球性白血病患者使用Obinutuzumab 加 Chlorambucil 相較於Rituximab 加 Chlorambucil作為第一線藥物之成本效用分析

Cost-effectiveness of Obinutuzumab plus Chlorambucil compares with Rituximab plus Chlorambucil for the first-line treatment of late-stage Chronic Lymphocytic Leukemia patients in Taiwan

沈祐任(Yu-Jen Shen)

指導教授 ： 楊銘欽

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2020年)

https://doi.org/10.6342/NTU202001262

摘要

目的：本研究使用衛生福利部中央健康保險署之觀點，利用經濟評估方法比較台灣晚期CD20陽性之慢性淋巴球白血病患者接受單株抗體Obinutuzumab併用化學治療藥物Chlorambucil (G-CLB) 治療策略相較於株抗體Rituximab併用化學治療藥物Chlorambucil (R-CLB) 治療策略之成本效用。

方法：由2014至2016年之全民健康保險研究資料庫兩百萬抽樣歸人檔獲得晚期慢性淋巴球白血病患者之真實資料，統計分析後得到病患接受治療之疾病無惡化存活期與疾病惡化存活期之醫療成本，並使用文獻回顧取得疾病無惡化存活期（Progression-Free Survival, PFS）、整體存活期（Overall Survival, OS）、風險比值（Hazard ratio, HR）與各項健康狀態之健康效用值(Utilities)，最後以馬可夫模型模擬20年之慢性淋巴球白血病病患使用新治療策略G-CLB及R-CLB治療藥物組合策略之成本差異後，進行成本效用分析及多維敏感度分析，計算遞增成本效果比值（Incremental Cost-Effectiveness Ratio, ICER）。

結果：晚期CD20陽性之慢性淋巴球白血病患者病患使用G-CLB治療策略相對R-CLB治療策略，LYs增加0.55，QUALYs增加0.36，且遞增成本效果比值(ICER)分別為-231,252.95與-359,036.58，低於成本效用閾值，即代表G-CLB相較於R-CLB為具有優勢之治療模式，且使用G-CLB治療策略可用較低之成本得到較佳之治療效果。

關鍵字

慢性淋巴球白血病 ； 醫療費用 ； 成本效用分析

並列摘要

Objective:
The study aimed to estimate the cost-utility of Obinutuzumab treatment (G-CLB) as first-line medication on Chronic Lymphocytic Leukemia (CLL) patients comparing to Rituximab treatment (R-CLB) from the payer’s perspective in Taiwan.
Methods:
A cost-utility analysis was conducted using a Markov model from the National Health Insurance Administrative perspective. Real-world data and costs were obtained from National Health Insurance Research Database to calculate the maintenance cost of progression-free survival health state and progression survival health state of late stage CLL patients using chemotherapy as main treatment strategy. On the other hand, progression-free survival, overall survival, hazard ratios, and utilities of each health states obtained from literature review were used to simulate the survival conditions separately for late stage CD20 positive CLL patients using G-CLB treatment or R-CLB treatment.
Results:
Compared to R-CLB treatment, late-stage CD20 positive CLL patients using G-CLB treatment as first-line medication resulted in gaining 0.55 life-years (LYs) and 0.36 quality-adjusted life-years (QALYs),yielding ICER values of -231,252.95 and -359,036.58, respectively. The results sugest that G-CLB are dominant treatment stragege when compared to R-CLB.

並列關鍵字

Chronic Lymphocytic Leukemia ； Obinutuzumab ； Rituximab ； Medical cost ； Cost-utility analysis

參考文獻

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