title: Cost-effectiveness of adding rituximab to fludarabine and cyclophosphamide for the treatment of previously untreated chronic lymphocytic leukemia.
abstract: A recent phase III trial demonstrated improved progression-free survival (PFS) and overall survival (OS) associated with adding rituximab to fludarabine and cyclophosphamide (R-FC) compared to FC in treatment of previously untreated chronic lymphocytic leukemia (CLL). A cost-effectiveness analysis of R-FC over FC was performed from a US third-party payer perspective over a lifetime horizon in the base case. One-way, two-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results. A secondary analysis was performed by also considering a societal perspective. R-FC was associated with an incremental 1.15 quality-adjusted life-years (QALYs) compared to FC and resulted in an incremental cost-effectiveness ratio of $23 530 per QALY in the base case and $31 513 per QALY considering a societal perspective. Results were most sensitive to time horizon, discount rate and unit drug cost for rituximab. Within the limitations of modeling long-term outcomes, R-FC is cost-effective for previously untreated CLL.
authors.affiliation: Cedar Associates LLC, Menlo Park, CA 94025, USA. jhornberger@cedarecon.com
authors.forename: John
authors.initials: J
authors.lastname: Hornberger
authors.forename: Carolina
authors.initials: C
authors.lastname: Reyes
authors.forename: Ashwini
authors.initials: A
authors.lastname: Shewade
authors.forename: Susan
authors.initials: S
authors.lastname: Lerner
authors.forename: Mark
authors.initials: M
authors.lastname: Friedmann
authors.forename: Leona
authors.initials: L
authors.lastname: Han
authors.forename: Hialy
authors.initials: H
authors.lastname: Gutierrez
authors.forename: Sacha
authors.initials: S
authors.lastname: Satram-Hoang
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keating
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D000069283:Rituximab; D015996:Survival Rate; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine