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Risk-Adapted Combined-Modality Therapy in Early-Stage Extranodal Natural Killer-/T-Cell Lymphoma: A Markov

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Combined-modality therapy (CMT) offers survival benefits for early-stage extranodal natural killer-/T-cell lymphoma (ENKTCL) but is not cost-effective for low-risk patients. High-risk patients show significant cost-effectiveness with CMT.

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Area of Science:

  • Oncology
  • Health Economics

Background:

  • Combined-modality therapy (CMT) improves survival in early-stage extranodal natural killer-/T-cell lymphoma (ENKTCL) compared to radiotherapy (RT) alone.
  • However, its cost-effectiveness for low-risk patients, defined by the nomogram-revised risk index (NRI), remains uncertain.

Purpose of the Study:

  • To evaluate the cost-effectiveness of CMT versus RT alone for early-stage ENKTCL across different risk groups.
  • To determine if survival benefits of CMT outweigh its additional costs for various patient risk strata.

Main Methods:

  • A Markov model was utilized to compare CMT and RT alone for five risk groups based on NRI.
  • Data on transition probabilities, effectiveness, and costs were sourced from the China Lymphoma Collaborative Group cohort.
  • Health utilities were estimated from adverse effects, with analyses conducted from Chinese payer perspectives.

Main Results:

  • CMT increased life-years across all risk groups, with varying incremental cost-effectiveness ratios (ICERs).
  • For low-risk (NRI=0) and intermediate-low-risk (NRI=1) groups, CMT was not cost-effective at a willingness-to-pay (WTP) threshold of $5,208 USD/QALY.
  • High-risk (NRI=3) and very high-risk (NRI=4) groups demonstrated high probabilities (72.07% and 99.10%) of cost-effectiveness, respectively.

Conclusions:

  • CMT is unlikely to be cost-effective for low-risk early-stage ENKTCL patients.
  • CMT is highly likely to be cost-effective for high-risk and very high-risk patients.
  • The cost-effectiveness for intermediate-risk groups is dependent on the time horizon and WTP threshold.