title: [Economic evaluation of rituximab added to fludarabine plus cyclophosphamide versus fludarabine plus cyclophosphamide for the treatment of chronic lymphocytic leukemia].
abstract: OBJECTIVE
  We evaluated the cost-effectiveness of rituximab added to the chemotherapy regimen of fludarabine plus cyclophosphamide (R-FC) versus fludarabine plus cyclophosphamide (FC) for the treatment of patients with previously untreated or relapsed/refractory chronic lymphocytic leukemia (CLL).
  
  
  METHODS
  Two Markov models were built, using published results on progression-free survival (PFS) in patients receiving first- or second-line therapy with R-FC vs FC, rates of disease progression and mortality rates in Spain. Patient-elicited utilities were applied to PFS and progressed health states. The cost of drugs, supportive care, and quality-adjusted life years (QALY) were estimated over a 10-year period. Univariate and probabilistic (Monte Carlo) sensitivity analyses were performed.
  
  
  RESULTS
  The addition of rituximab to chemotherapy in first- and second-line therapy increased life-years gained (LYG) and QALYs compared with chemotherapy. The incremental cost per LYG and QALY gained was €20,703 and €19,343 for first-line treatment and was €23,183 and €24,781 for second-line treatment.
  
  
  CONCLUSIONS
  In patients with previously untreated or relapsed/refractory CLL, the addition of rituximab to the FC regimen increased life expectancy and quality-adjusted life expectancy. In both types of patient, the treatment was cost-effective.
authors.affiliation: Hospital Virgen de la Salud, Toledo, España.
authors.forename: Luis Felipe
authors.initials: LF
authors.lastname: Casado
authors.forename: José Antonio
authors.initials: JA
authors.lastname: García Marco
authors.forename: Florinda
authors.initials: F
authors.lastname: Gilsanz
authors.forename: Marcos
authors.initials: M
authors.lastname: González
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ríos
authors.forename: Javier
authors.initials: J
authors.lastname: de la Serna
authors.forename: Alvaro
authors.initials: A
authors.lastname: Urbano
authors.forename: Vicente
authors.initials: V
authors.lastname: Vicente
authors.forename: Carlos
authors.initials: C
authors.lastname: Rubio-Terrés
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Castro
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics*; D018450:Disease Progression; D018572:Disease-Free Survival; D017048:Health Care Costs; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D008390:Markov Chains; D008962:Models, Theoretical; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D000069283:Rituximab; D016879:Salvage Therapy / Q000191:economics; D013030:Spain; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine