title: Cost-effectiveness of maintenance rituximab treatment after second line therapy in patients with follicular lymphoma in Sweden.
abstract: BACKGROUND
  Rituximab has significantly improved the prognosis for patients with both indolent and aggressive non-Hodgkin's lymphoma. An economic evaluation was carried out to assess the cost-effectiveness in Sweden of rituximab as maintenance therapy for patients with follicular lymphoma in remission after second line therapy.
  
  
  METHODS
  The incremental cost and effectiveness of rituximab maintenance therapy versus observation were evaluated in a health-state transition model. Primary effect measures were quality-adjusted life-years (QALY) and life-years gained (LYG). Model state transitions were calculated based on progression-free and overall survival data from the EORTC20981 trial. The analysis was made from the perspective of the healthcare provider, including direct medical costs presented in euro, 2007 value. Effects and costs were discounted at a 3% annual rate. The stability of the base case results were tested in one-way and probabilistic sensitivity analyses.
  
  
  RESULTS
  The evaluation assessed rituximab maintenance therapy to be associated with an incremental cost per QALY gained of euro 12,600 and an incremental cost per LYG of euro 11,200. The average discounted life expectancy for patients on rituximab maintenance was 1.0 year longer than for patients on observation (5.96 vs. 4.94 years). Rituximab maintenance was associated with an additional 0.9 QALY, and total costs per patient were euro 11,500 higher in the treatment arm, compared to observation.
  
  
  CONCLUSIONS
  The results indicate that rituximab maintenance treatment after successful induction therapy for patients with relapsed/refractory follicular lymphoma in Sweden is cost-effective compared to observation.
authors.affiliation: i3 Innovus, Stockholm, Sweden. Frida.K@healtheconomics.se
authors.forename: Frida
authors.initials: F
authors.lastname: Kasteng
authors.forename: Martin
authors.initials: M
authors.lastname: Erlanson
authors.forename: Hans
authors.initials: H
authors.lastname: Hagberg
authors.forename: Eva
authors.initials: E
authors.lastname: Kimby
authors.forename: Thomas
authors.initials: T
authors.lastname: Relander
authors.forename: Jonas
authors.initials: J
authors.lastname: Lundkvist
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D016527:Drug Costs; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012074:Remission Induction; D000069283:Rituximab; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab