title: Bendamustine versus chlorambucil for the first-line treatment of chronic lymphocytic leukemia in England and Wales: a cost-utility analysis.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of bendamustine compared with chlorambucil as first-line treatment for patients with chronic lymphocytic leukemia who would be considered unsuitable for treatment with fludarabine combination chemotherapy regimens.
  
  
  METHODS
  A semi-Markov approach was used to estimate time in each health state. The model was parameterized primarily by using data from a phase III randomized, open-label trial comparing bendamustine with chlorambucil. It captured the increased progression-free survival and improved response rates with bendamustine, and the cost and quality of life impacts of postprogression treatments. The analysis was conducted from the perspective of the National Health Service in England and Wales. A lifetime (35-year) time horizon was used. Deterministic sensitivity analyses, probabilistic sensitivity analyses, and subgroup analyses in older patients and patients with poor performance status were carried out.
  
  
  RESULTS
  The estimated incremental cost-effectiveness ratio was £ 11,960 per quality-adjusted life-year. None of the deterministic sensitivity analyses increased the incremental cost-effectiveness ratio by more than £ 2000. Subgroup analyses showed that bendamustine remained cost-effective across different patient groups. Probabilistic sensitivity analysis showed that at the £ 20,000 threshold, bendamustine has a 90% probability of being cost-effective.
  
  
  CONCLUSIONS
  Bendamustine represents good value for first-line treatment of patients with chronic lymphocytic leukemia who are unsuitable for treatment with fludarabine combination chemotherapy. The incremental cost-effectiveness ratio is below the thresholds commonly applied in England and Wales (£ 20,000-£ 30,000 per quality-adjusted life-year).
authors.affiliation: Oxford Outcomes, Oxford, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Woods
authors.forename: Neil
authors.initials: N
authors.lastname: Hawkins
authors.forename: William
authors.initials: W
authors.lastname: Dunlop
authors.forename: Alison
authors.initials: A
authors.lastname: O'Toole
authors.forename: Steve
authors.initials: S
authors.lastname: Bramham-Jones
mesh_terms: D000367:Age Factors; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000191:economics / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride; D002699:Chlorambucil / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D004739:England; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000191:economics; D008390:Markov Chains; D008875:Middle Aged; D009313:National Health Programs; D009588:Nitrogen Mustard Compounds / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014852:Wales
chemical_list: D018906:Antineoplastic Agents, Alkylating; D009588:Nitrogen Mustard Compounds; D002699:Chlorambucil; D000069461:Bendamustine Hydrochloride