Cost-effectiveness analysis of rituximab combined with chop for treatment of diffuse large B-cell lymphoma.
OBJECTIVE
To estimate the cost-effectiveness from a French payer perspective of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) alone compared with CHOP plus rituximab (R-CHOP) for treatment of patients with diffuse large B-cell lymphoma.


METHODS
Mean patient survival, days of hospitalization, and chemotherapy costs during treatment were estimated from a Phase III trial in France, Belgium, and Switzerland. Survival during the trial was estimated using the Kaplan-Meier method; survival beyond the trial period was projected based on mortality rates from the Scottish and Newcastle Lymphoma Group database. French diagnosis-related group (DRG) payment schedules were applied to trial data to estimate cost of adverse events and drug administration. We estimated survival and cost-effectiveness [the incremental cost per quality-adjusted life-year (QALY) gained] from 4 years (median clinical trial follow-up period) to 15 years, discounted at a fixed annual rate of 3%. We used published patient preferences. We converted currency to euros, based on 2003 exchange rates.


RESULTS
R-CHOP resulted in a 20.6% relative increase in complete response rate (absolute increase from 63% to 76%), and a 31% decrease in risk of death at 4 years (95% CI 8-49%). Over a 15-year time horizon, mean overall survival (OS) duration was estimated to be 6.90 years for R-CHOP and 5.74 years for CHOP, a mean increase in OS of 1.16 years (or 1.07 QALYs). Total direct medical costs were 13,170 euro higher with R-CHOP, with an incremental cost-effectiveness ratio of 12,259 euro per QALY gained.


CONCLUSIONS
R-CHOP significantly increases mean OS up to 4 years compared with CHOP, and its cost-effectiveness ratio compares favorably with other oncology treatments in widespread use.
Best
Jennie H
JH
Department of Pharmacy, University of Washington, Seattle, WA 98195, USA.
Hornberger
John
J
Proctor
Stephen J
SJ
Omnes
Louis F
LF
Jost
Fred
F
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000191:economics / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D011241:Prednisone / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000069283:Rituximab; D015996:Survival Rate; D014750:Vincristine / Q000191:economics / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone