Cost-effectiveness of extended adjuvant rituximab for US patients aged 65-70 years with follicular lymphoma in second remission.
OBJECTIVE
A recent Intergroup trial showed that receiving adjuvant rituximab after having a second remission from follicular lymphoma (FL) improved progression-free and overall survival (OS). The current study was conducted to determine the incremental cost-effectiveness ratio of this strategy in the United States.


METHODS
We constructed a transition state model to estimate the incremental cost-effectiveness ratio of extended adjuvant rituximab for 2 years for patients having a second FL remission. Event-free and OS rates were estimated from the recently published Intergroup trial. These were adjusted to reflect the contribution of non-cancer-specific mortality for patients aged 65-70 years, a more commonly affected age group than in the Intergroup trial, which had a median age of 54 years. Previously reported quality of life and cost estimates were obtained from peer-reviewed sources.


RESULTS
Five years after a second induction with R-CHOP (rituximab with cyclophosphamide/doxorubicin/vincristine/ prednisone), disease-free survival is expected to be 47% and 22%, and the OS rates are estimated to be 73% and 61% for extended adjuvant rituximab and observation, respectively, during the second remission. The discounted incremental cost-effectiveness ratio for the addition of adjuvant rituximab is estimated to be $19,522 per quality-adjusted life-years gained.


CONCLUSIONS
Extended adjuvant rituximab offers a clinical benefit to patients aged 65-70 years who have a second remission from FL at a cost generally acceptable to the US healthcare system.
Hayslip
John W
JW
Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA. j.hayslip@uky.edu
Simpson
Kit N
KN
D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000191:economics*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics; D017024:Chemotherapy, Adjuvant / Q000191:economics / Q000379:methods; D003365:Costs and Cost Analysis / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D008297:Male; D008954:Models, Biological; D011241:Prednisone / Q000008:administration & dosage / Q000191:economics; D012074:Remission Induction / Q000379:methods; D000069283:Rituximab; D015996:Survival Rate; D014481:United States; D014750:Vincristine / Q000008:administration & dosage / Q000191:economics
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone