Prophylaxis for Pneumocystis carinii pneumonia in non-Hodgkin's lymphoma undergoing R-CHOP21 in China: a meta-analysis and cost-effectiveness analysis

Xiaojia Huang; Xiaoting Huang; Shen Lin; Shaohong Luo; Liangliang Dong; Dong Lin; Yaping Huang; Chen Xie; Dongni Nian; Xiongwei Xu; Xiuhua Weng

doi:10.1136/bmjopen-2022-068943

Prophylaxis for Pneumocystis carinii pneumonia in non-Hodgkin's lymphoma undergoing R-CHOP21 in China: a meta-analysis and cost-effectiveness analysis

BMJ Open. 2023 Mar 27;13(3):e068943. doi: 10.1136/bmjopen-2022-068943.

Authors

Xiaojia Huang^{1

2}, Xiaoting Huang^{1

2}, Shen Lin^{1

2}, Shaohong Luo^{1

2}, Liangliang Dong³, Dong Lin^{1

2}, Yaping Huang^{1

2}, Chen Xie^{1

2}, Dongni Nian^{1

2}, Xiongwei Xu^{1

2}, Xiuhua Weng^{4

2}

Affiliations

¹ Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
² Department of Pharmacy, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
³ Department of Pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
⁴ Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China wxh001@fjmu.edu.cn.

Abstract

Objective: Rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone, once every 3 weeks (R-CHOP21) is commonly used in non-Hodgkin's lymphoma (NHL), but accompanied by Pneumocystis carinii pneumonia (PCP) as a fatal treatment complication. This study aims to estimate the specific effectiveness and cost-effectiveness of PCP prophylaxis in NHL undergoing R-CHOP21.

Design: A two-part decision analytical model was developed. Prevention effects were determined by systemic review of PubMed, Embase, Cochrane Library and Web of Science from inception to December 2022. Studies reporting results of PCP prophylaxis were included. Enrolled studies were quality assessed with Newcastle-Ottawa Scale. Costs were derived from the Chinese official websites, and clinical outcomes and utilities were obtained from published literature. Uncertainty was evaluated through deterministic and probabilistic sensitivity analyses (DSA and PSA). Willingness-to-pay (WTP) threshold was set as US$31 315.23/quality-adjusted life year (QALY) (threefold the 2021 per capita Chinese gross domestic product).

Setting: Chinese healthcare system perspective.

Participants: NHL receiving R-CHOP21.

Interventions: PCP prophylaxis versus no prophylaxis.

Main outcome measures: Prevention effects were pooled as relative risk (RR) with 95% CI. QALYs and incremental cost-effectiveness ratio (ICER) were calculated.

Results: A total of four retrospective cohort studies with 1796 participants were included. PCP risk was inversely associated with prophylaxis in NHL receiving R-CHOP21 (RR 0.17; 95% CI 0.04 to 0.67; p=0.01). Compared with no prophylaxis, PCP prophylaxis would incur an additional cost of US$527.61, and 0.57 QALYs gained, which yielded an ICER of US$929.25/QALY. DSA indicated that model results were most sensitive to the risk of PCP and preventive effectiveness. In PSA, the probability that prophylaxis was cost-effective at the WTP threshold was 100%.

Conclusion: Prophylaxis for PCP in NHL receiving R-CHOP21 is highly effective from retrospective studies, and routine chemoprophylaxis against PCP is overwhelmingly cost-effective from Chinese healthcare system perspective. Large sample size and prospective controlled studies are warranted.

Keywords: health economics; interstitial lung disease; lymphoma.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Cost-Effectiveness Analysis
Humans
Lymphoma, Non-Hodgkin* / drug therapy
Male
Pneumonia, Pneumocystis* / prevention & control
Prospective Studies
Prostate-Specific Antigen
Quality-Adjusted Life Years
Retrospective Studies

Substances

Prostate-Specific Antigen