title: Cost effectiveness of rituximab for non-Hodgkin's lymphoma: a systematic review.
abstract: BACKGROUND
  The monoclonal antibody rituximab has shown clinical effectiveness in combination with chemotherapy for the treatment of non-Hodgkin's lymphoma (NHL) in several randomized controlled studies. Rituximab maintenance therapy is associated with significant improvement in progression-free and overall survival in patients with NHL. However, treatment with rituximab causes considerable costs for healthcare systems.
  
  
  OBJECTIVE
  This article provides an overview of economic evaluations of rituximab and appraises their methodological quality.
  
  
  METHODS
  A systematic literature search of cost-effectiveness studies on rituximab was carried out in nine electronic databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR), the German Agency of Health Technology Assessment (DAHTA) database, German Institute for Quality Improvement (DIQ)-Literatur, DIQ-Projekte, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessments (HTA) database and Sozialmedizin (SOMED) [languages: English, German, Dutch, French, Spanish and Italian; publication period: 1998 to 2010]. Based on pre-specified inclusion criteria, cost-effectiveness studies were identified that compared standard chemotherapy with standard chemotherapy plus rituximab in patients with a subtype of NHL. The methodological quality of the studies was assessed using a quality checklist.
  
  
  RESULTS
  Fourteen economic evaluations from seven different countries were included in the review. All economic evaluations reported incremental cost-effectiveness ratios (ICERs) for the add-on therapy with rituximab that were below the country-specific thresholds. The studies differed significantly in their characteristics and methodological rigour. Most studies lacked transparency regarding identification and justification of data. In several studies, the rationale for the model structure was not described appropriately.
  
  
  CONCLUSIONS
  Adding rituximab to standard chemotherapy is considered a cost-effective treatment option for NHL. However, the results of the analyses should be interpreted with caution due to methodological limitations.
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne-AR, Cologne, Germany. P.Auweiler@web.de
authors.forename: Philipp W P
authors.initials: PW
authors.lastname: Auweiler
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
authors.forename: Andreas
authors.initials: A
authors.lastname: Gerber
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics* / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D006291:Health Policy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012107:Research Design; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab