title: Gemcitabine/dexamethasone/cisplatin vs cytarabine/dexamethasone/cisplatin for relapsed or refractory aggressive-histology lymphoma: cost-utility analysis of NCIC CTG LY.12.
abstract: BACKGROUND
  The NCIC CTG LY.12 study showed that gemcitabine, dexamethasone, and cisplatin (GDP) were noninferior to dexamethasone, cytarabine, and cisplatin (DHAP) in patients with relapsed or refractory aggressive histology lymphoma prior to autologous stem cell transplantation. We conducted an economic evaluation from the perspective of the Canadian public healthcare system based on trial data.
  
  
  METHODS
  The primary outcome was an incremental cost utility analysis comparing costs and benefits associated with GDP vs DHAP. Resource utilization data were collected from 519 Canadian patients in the trial. Costs were presented in 2012 Canadian dollars and disaggregated to highlight the major cost drivers of care. Benefit was measured as quality-adjusted life-years (QALYs) based on utilities translated from prospectively collected quality-of-life data. All statistical tests were two-sided.
  
  
  RESULTS
  The mean overall costs of treatment per patient in the GDP and DHAP arms were $19 961 (95% confidence interval (CI) = $17 286 to $24 565) and $34 425 (95% CI = $31 901 to $39 520), respectively, with an incremental difference in direct medical costs of $14 464 per patient in favor of GDP (P < .001). The predominant cost driver for both treatment arms was related to hospitalizations. The mean discounted quality-adjusted overall survival with GDP was 0.161 QALYs and 0.152 QALYs for DHAP (difference = 0.01 QALYs, P = .146). In probabilistic sensitivity analysis, GDP was associated with both cost savings and improved quality-adjusted outcomes compared with DHAP in 92.6% of cost-pair simulations.
  
  
  CONCLUSIONS
  GDP was associated with both lower costs and similar quality-adjusted outcomes compared with DHAP in patients with relapsed or refractory lymphoma. Considering both costs and outcomes, GDP was the dominant therapy.
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD). matthew.cheung@sunnybrook.ca.
authors: Matthew C
authors: MC
authors: Cheung
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Annette E
authors: AE
authors: Hay
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Michael
authors: M
authors: Crump
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Kevin R
authors: KR
authors: Imrie
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Yuyao
authors: Y
authors: Song
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Shazia
authors: S
authors: Hassan
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Nancy
authors: N
authors: Risebrough
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Jonathan
authors: J
authors: Sussman
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Stephen
authors: S
authors: Couban
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: David
authors: D
authors: MacDonald
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Vishal
authors: V
authors: Kukreti
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: C Tom
authors: CT
authors: Kouroukis
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Tara
authors: T
authors: Baetz
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: David
authors: D
authors: Szwajcer
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Pierre
authors: P
authors: Desjardins
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Lois
authors: L
authors: Shepherd
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Ralph M
authors: RM
authors: Meyer
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Al
authors: A
authors: Le
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Bingshu E
authors: BE
authors: Chen
authors: Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
authors: Nicole
authors: N
authors: Mittmann
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D002170:Canada; D002945:Cisplatin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003561:Cytarabine / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D000093542:Gemcitabine
chemical_list: D003561:Cytarabine; D003841:Deoxycytidine; D003907:Dexamethasone; D002945:Cisplatin; D000093542:Gemcitabine