Cost determinants in aggressive non-Hodgkin's lymphoma.
OBJECTIVE
The 5 factors of the International Prognostic Index (IPI) for aggressive non Hodgkin's lymphoma (NHL) age, disease stage, serum lactate dehydrogenase (LDH), performance status, number of extranodal sites) are validated predictors of a patient's survival. Given the need for economic evaluations, we analyzed whether the IPI and the presence of B-symptoms (night sweats, fever, weight loss) can identify subgroups of patients with favorable or unfavorable cost profiles.


METHODS
Chart data for 374 patients with newly diagnosed stage II-IV aggressive NHL treated between 1993-2001 with CHOP chemotherapy were used. Costs were calculated up to two years from the start of treatment. The cost of granulocyte colony-stimulating factor (G-CSF) was not included, as some patients received this due to trial participation. Regression analyses and non-parametric bootstrap tests were performed to determine the significance of prognostic factors.


RESULTS
Mean first-line treatment costs (excluding G-CSF) were pound sterling 10047 (<60 years) and pound sterling 12232 (>60 years). Two-year follow-up costs averaged pound sterling 14039 and pound sterling 9026 for the two age groups, respectively. The 5 IPI variables, the 2 IPI risk group variables (resulting from the 5 factors) and B-symptoms all showed significant univariate associations with first-line treatment costs. They were also associated with higher 2-year costs, except for age, LDH, and standard risk group index. Lower predictability of total 2-year costs was due to wide variations in second-line treatments.


CONCLUSIONS
The IPI factors and B-symptoms are predictive of treatment costs. The detailed information presented in this paper is of value for those who need to make cost-effectiveness estimations in NHL, which is a relevant topic, given new treatment modalities that are emerging.
van Agthoven
Michel
M
Institute for Medical Technology Assessment, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. m.vanagthoven@erasmusmc.nl
Sonneveld
Pieter
P
Verdonck
Leo F
LF
Uyl-de Groot
Carin A
CA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics; D002648:Child; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D016527:Drug Costs; D005260:Female; D005334:Fever / Q000453:epidemiology; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013546:Sweating; D015431:Weight Loss
D009363:Neoplasm Proteins; D016179:Granulocyte Colony-Stimulating Factor; D007770:L-Lactate Dehydrogenase