Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma.
BACKGROUND
Findings from the Groupe d'Etude des Lymphomes Adultes LNH 98-5 study showed that rituximab added to combined cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) prolonged progression-free survival and overall survival in adults age >/= 60 years with diffuse large B-cell non-Hodgkin lymphoma (DLBCL). The current study was conducted to investigate the incremental cost utility of the addition of rituximab to CHOP (R-CHOP) compared with CHOP alone.


METHODS
Clinical prognosis of the time to disease progression and death was estimated using published evidence from the LNH 98-5 study (n = 399 patients) that was linked mathematically to published long-term outcome data on patients with DLBCL. Drug-acquisition costs were based on published data from formulary pricing sources, and the costs of cancer surveillance and end-of-life care were based on published literature sources. The authors assessed cost utility as the difference in costs between R-CHOP and CHOP divided by the increase in expected overall survival adjusted for quality of life.


RESULTS
Over 5 years, it was projected that R-CHOP would prolong overall survival by 1.04 years. The mean cumulative cost of CHOP was 3358 dollars, and the mean cost of R-CHOP was 17,225 dollars, resulting in a cumulative net increase of 13,867 dollars. The posttreatment cancer surveillance cost for CHOP was 3950 dollars, compared with 5202 dollars for R-CHOP. It was estimated that R-CHOP would have a cost-utility ratio of 19,297 dollars per year of life gained compared with CHOP when adjusted for quality of life. R-CHOP remained cost effective over wide ranges of variables in sensitivity analyses.


CONCLUSIONS
Compared with CHOP alone, it was predicted that R-CHOP would be cost effective in elderly patients with DLBCL.
Hornberger
John C
JC
Department of Clinical Economics, Acumen LLC/The SPHERE Institute, Burlingame, California, USA. jhornberger@acumen.llc.com
Best
Jennie H
JH
D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000191:economics; D016527:Drug Costs; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D008433:Mathematics; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000191:economics; D011788:Quality of Life; D000069283:Rituximab; D015996:Survival Rate; D013997:Time Factors; D014481:United States; D014750:Vincristine / Q000008:administration & dosage / Q000191:economics
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone