Cost analysis of common treatment options for indolent follicular non-Hodgkin's lymphoma.
OBJECTIVE
We assessed direct health care costs associated with the most commonly prescribed treatments for indolent follicular non-Hodgkin's lymphoma (FL).


METHODS
New and previously diagnosed FL patients (>or=18 years) known during 1997-1998 to 15 Dutch hospitals were selected for inclusion. Each patient was followed for 3 years, and resource use associated with each of the treatments, including watchful waiting, was recorded. The hospital perspective was adopted. Unit costs were based on 2003 price levels.


RESULTS
Two hundred patients were included of whom 75% underwent one or more treatments during the 3-year data collection period [25% were not treated because of a watchful waiting strategy (10%) or complete remission (15%)]. Allogeneic and autologous stem cell transplantations were the most expensive treatments, with a mean (median) per patient cost of 45,326 euro(44,237; n=7) and 18,866 euro (16,532; n=9), respectively (up to discharge only). Intravenous fludarabine cost 10,651 euro (9,995; n=33), rituximab (10,628 euro; 10,124; n=7), and CHOP 7,547 euro (5,833; n=42). Classical FL treatments were found to be the least expensive treatments used with an estimated cost for cylophosphamide, vincristine and prednisone of 5,268 euro (2,644; n=58), for radiotherapy of 4,218 euro (4,313; n=52), and for chlorambucil of 2,476 euro (1,098; n=53).


CONCLUSIONS
This study presents information on resource use and costs associated with the most commonly prescribed FL treatments. In addition to differences in effectiveness, commonly used treatments vary considerably in terms of resource use and overall cost. This information is of value for resource planning, given the high costs of new treatment modalities.
van Agthoven
Michel
M
Institute for Medical Technology Assessment, Department of Health Policy and Management, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. m.vanagthoven@erasmusmc.nl
Kramer
Mark H H
MH
Sonneveld
Pieter
P
van der Hem
Klaas G
KG
Huijgens
Peter C
PC
Wijermans
Pierre W
PW
Kluin-Nelemans
Hanneke C
HC
Schaafsma
M Ronald
MR
Biesma
Douwe H
DH
Mattijssen
Vera
V
Uyl-de Groot
Carin A
CA
Hagenbeek
Anton
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics; D003365:Costs and Cost Analysis / Q000191:economics; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D008224:Lymphoma, Follicular / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000191:economics
D000970:Antineoplastic Agents