title: Cost-effectiveness of rituximab as maintenance treatment for relapsed follicular lymphoma: results of a population-based study.
abstract: OBJECTIVE
  On the basis of two population-based registries, our study aims to calculate the real-world cost-effectiveness of rituximab maintenance compared with observation in relapsed or refractory follicular lymphoma patients who responded to second-line chemotherapy.
  
  
  METHODS
  Data were obtained from the EORTC20981 trial, the Netherlands Cancer Registry and two population-based registries. A Markov model was developed to calculate cost per life year gained (LYG) and quality-adjusted life years (QALYs) for three scenarios.
  
  
  RESULTS
  Our real-world patients were (62 years) 6 to 7 years older and had higher complete response rates to second-line chemotherapy than the trial population. Differences between the real-world rituximab and observation group were observed for second-line chemotherapy and disease progression. Groups were more balanced after using propensity matching. Relying entirely on updated trial results (scenario1) in combination with local cost data resulted in ratios of €11,259 per LYG and €12,655 per QALY. For scenario2, consisting of trial efficacy and matched real-world costs, ratios of €21,202 per LYG and €23,821 per QALY were calculated. Using real-world matched evidence (scenario3) for both effectiveness and costs showed ratios of €10,591 per LYG and €11,245 per QALY.
  
  
  CONCLUSIONS
  Although differences in real-world and trial population were found, using real-world data as well as results from long-term trial follow-up showed favourable ICERs for rituximab maintenance. Nevertheless, results showed that caution is required with data synthesis, interpretation and generalisability of results. As different scenarios provide answers to different questions, we recommend healthcare decision-makers to recognise the importance of calculating several cost-effectiveness scenarios.
authors.affiliation: Department of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Hedwig M
authors.initials: HM
authors.lastname: Blommestein
authors.forename: Djamila E
authors.initials: DE
authors.lastname: Issa
authors.forename: Marjolein
authors.initials: M
authors.lastname: Pompen
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ten Hoor
authors.forename: Mels
authors.initials: M
authors.lastname: Hogendoorn
authors.forename: Peter
authors.initials: P
authors.lastname: Joosten
authors.forename: Sonja
authors.initials: S
authors.lastname: Zweegman
authors.forename: Peter C
authors.initials: PC
authors.lastname: Huijgens
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012042:Registries; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: cost-effectiveness; drug policy regulations; follicular lymphoma; healthcare decision-making; non-Hodgkin lymphoma; population based; real-world data; rituximab