title: Cost-effectiveness of rituximab in addition to fludarabine and cyclophosphamide (R-FC) for the first-line treatment of chronic lymphocytic leukemia.
abstract: The cost-effectiveness of rituximab in combination with fludarabine/cyclophosphamide (R-FC) for the first line treatment of chronic lymphocytic leukemia (CLL) was evaluated. Based on long-term clinical data (follow-up of 5.9 years) from the CLL8-trial, a Markov-model with three health states (Free from disease progression, Progressive disease, Death) was used to evaluate the cost per quality-adjusted life-year (QALY) and cost per life years gained (LYG) of R-FC from the perspective of the German statutory health insurance (SHI). The addition of rituximab to FC chemotherapy results in a gain of 1.1 quality-adjusted life-years. The incremental cost-effectiveness ratio (ICER) of R-FC compared with FC was €17,979 per QALY (€15,773 per LYG). Results were robust in deterministic and probabilistic sensitivity analyses. From the German SHI perspective, rituximab in combination with FC chemotherapy represents good value for first-line treatment of patients with CLL and compares favorably with chemotherapy alone.
authors.affiliation: a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany ;
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.affiliation: b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany ;
authors.forename: Kirsten
authors.initials: K
authors.lastname: Fischer
authors.affiliation: a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany ;
authors.forename: Peter
authors.initials: P
authors.lastname: Kaiser
authors.affiliation: b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany ;
authors.forename: Barbara
authors.initials: B
authors.lastname: Eichhorst
authors.affiliation: c SVA Zürich , Zürich , Switzerland ;
authors.forename: Ronald
authors.initials: R
authors.lastname: Walshe
authors.affiliation: d PIOH, Praxis of Oncology and Hematology , Cologne , Germany ;
authors.forename: Marcel
authors.initials: M
authors.lastname: Reiser
authors.affiliation: e Oncology Information Service , Freiburg , Germany ;
authors.forename: Lenka
authors.initials: L
authors.lastname: Kellermann
authors.affiliation: a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany ;
authors.forename: Lisa
authors.initials: L
authors.lastname: Borsi
authors.affiliation: a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany ;
authors.forename: Daniele
authors.initials: D
authors.lastname: Civello
authors.affiliation: a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany ;
authors.forename: Alexander
authors.initials: A
authors.lastname: Mensch
authors.affiliation: b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany ;
authors.forename: Jasmin
authors.initials: J
authors.lastname: Bahlo
authors.affiliation: b Department of Internal Medicine and Centre for Integrated Oncology , University of Cologne , Cologne , Germany ;
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
authors.affiliation: a Institute of Health Economics and Clinical Epidemiology , University of Cologne , Cologne , Germany ;
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
authors.affiliation: f Pharmaceuticals Division , F. Hoffmann-LaRoche Ltd. , Basel , Switzerland.
authors.forename: Günter
authors.initials: G
authors.lastname: Fingerle-Rowson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; 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; D017048:Health Care Costs; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D000069283:Rituximab / Q000008:administration & dosage; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine
keywords: Rituximab; chronic lymphocytic leukemia; pharmacoeconomic analysis