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Myeloablative therapy is usually required before hematopoietic stem cell transplantation (HSCT), and the combination of high-dose radiotherapy and chemotherapy is a common pre-transplant conditioning regimen
.
Busulfan (Bu) is an alkylating agent, and intravenous Bu has higher pharmacokinetic (PK) predictability than oral administration
Myeloablative therapy is usually required before hematopoietic stem cell transplantation (HSCT), and the combination of high-dose radiotherapy and chemotherapy is a common pre-transplant conditioning regimen
The use of PK information in the individualized dosing of Bu can compensate for interindividual differences in drug processing and metabolism
Figure 1: Markov Model
Figure 1: Markov ModelFigure 2: Study Selection Flowchart
Figure 2: Study Selection FlowchartThe study used Markov models to estimate associated costs and health outcomes from a health system perspective
.
The primary outcomes of interest were life-cycle cost, quality-adjusted life-years (QALYs) earned, and incremental cost-effectiveness ratio (ICER) per dollar of QALY earned
The study used Markov models to estimate associated costs and health outcomes from a health system perspective
Figure 3: Meta-analysis results of ae forest plot group and drug dose group efficacy indicators (1) allo-HSCT and auto-HSCT subgroups, (2) overall survival AML/MDS and non-Hodgkin lymphoma subgroups, ( b1) progression-free survival in allo-HSCT and auto-HSCT subgroups, (b2) progression-free survival in AML/MDS and non-Hodgkin’s lymphoma subgroups, (c) relapse rates, safety metrics, (d) VOD and (e) Acute/chronic GVHD
Figure 3: Meta-analysis results of ae forest plot group and drug dose group efficacy indicators (1) allo-HSCT and auto-HSCT subgroups, (2) overall survival AML/MDS and non-Hodgkin lymphoma subgroups, ( b1) progression-free survival in allo-HSCT and auto-HSCT subgroups, (b2) progression-free survival in AML/MDS and non-Hodgkin’s lymphoma subgroups, (c) relapse rates, safety metrics, (d) VOD and (e) Acute/chronic GVHDThe results showed that progression-free survival and overall survival were higher in the PK-guided group than in the fixed-dose group, and the PK-guided group was associated with lower non-relapse mortality and relapse rates
.
Compared with safety, the incidence of acute graft-versus-host disease (GVHD) was the same in both groups ( P> 0.
The results showed that progression-free survival and overall survival were higher in the PK-guided group than in the fixed-dose group, and the PK-guided group was associated with lower non-relapse mortality and relapse rates
Figure 4: Tornado Plot: Results of One-Way Deterministic Sensitivity Analysis of Pk Boot vs.
fxed Dose
fxed Dose
Figure 5: Incremental cost-effectiveness scatterplot of PK-guided versus fxed dose groups
Figure 5: Incremental cost-effectiveness scatterplot of PK-guided versus fxed dose groupsCost-effectiveness analysis showed that QALYs in the PK-guided group (12.
8135 QALYs and $582,475.
07) increased by 2.
0609 relative to the fixed-dose group (10.
7526 QALYs and $562,833.
20), resulting in an ICER of $9530.
72/QALY
.
Univariate and probabilistic sensitivity analyses confirmed the reliability of the results
Cost-effectiveness analysis showed that QALYs in the PK-guided group (12.
Figure 6: Cost-benefit acceptability curves for both strategies
Figure 6: Cost-benefit acceptability curves for both strategiesOverall, pk guidance is a better option when Bu is a component of a myeloablative preparation regimen for HSCT patients
.
It has higher efficacy and safety and is more cost-effectiveIt has higher efficacy and safety and is more cost-effective
Original source:
Chen, T.
Chen, T.
, Chen, C.
, He, X.
et al.
Fixed-dose administration and pharmacokinetically guided adjustment of busulfan dose for patients undergoing hematopoietic stem cell transplantation: a meta-analysis and cost-effectiveness analysis.
Ann Hematol 101, 667–679 (2022).
https://doi.
org/10.
1007/s00277-021-04733-3 Leave a comment here
