title: Cost-Effectiveness Analysis of Bendamustine Plus Rituximab as a First-Line Treatment for Patients with Follicular Lymphoma in Spain.
abstract: BACKGROUND
  Follicular lymphoma (FL) is the second most common type of lymphoid cancer in Western Europe.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the cost utility of rituximab-bendamustine treatment compared with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) treatment as a first-line therapy for patients with advanced FL in Spain.
  
  
  METHODS
  A Markov model was developed to estimate the cost effectiveness of rituximab-bendamustine compared with R-CHOP as first-line treatment for patients with advanced FL in the Spanish National Health System (NHS). Transitions between health states (progression-free, including induction and maintenance; first relapse; second relapse; and death) were allowed for the patient cohort in 4-week-long cycles. Clinical data for the extrapolation of progression-free survival curves were obtained from randomized trials. Mortality rates and utilities were obtained from the literature. Outcomes were measured as quality-adjusted life-years (QALYs). The total costs (€, 2013) included drug costs (ex-factory prices with mandatory deductions), disease management costs and adverse event-associated costs. Costs and outcomes were discounted at a 3 % annual rate. Probabilistic sensitivity analysis was performed using 10,000 Monte Carlo simulations to assess the model robustness.
  
  
  RESULTS
  Treatment and administration costs during the induction phase were higher for rituximab-bendamustine (€17,671) than for R-CHOP (€11,850). At the end of the 25-year period, the rituximab-bendamustine first-line strategy had a total cost of €68,357 compared with €69,528 for R-CHOP. Health benefits were higher for rituximab-bendamustine treatment (10.31 QALYs) than for R-CHOP treatment (9.82 QALYs). In the probabilistic analysis, rituximab-bendamustine was the dominant strategy over treatment with R-CHOP in 53.4 % of the simulations.
  
  
  CONCLUSIONS
  First-line therapy with rituximab-bendamustine in FL patients was the dominant strategy over treatment with R-CHOP; it showed cost savings and higher health benefits for the Spanish NHS.
authors.affiliation: Pharmacoeconomics and Outcomes Research Iberia, Paseo Joaquín Rodrigo 4- letra I, Pozuelo de Alarcón, 28224, Madrid, Spain. esabater@porib.com.
authors.forename: Eliazar
authors.initials: E
authors.lastname: Sabater
authors.affiliation: Haematology Department, Hospital Clinic, Barcelona, Spain.
authors.forename: Armando
authors.initials: A
authors.lastname: López-Guillermo
authors.affiliation: Oncology Department, Hospital Costa del Sol, Marbella, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rueda
authors.affiliation: Haematology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salar
authors.affiliation: Pharmacoeconomics and Outcomes Research Iberia, Paseo Joaquín Rodrigo 4- letra I, Pozuelo de Alarcón, 28224, Madrid, Spain.
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
authors.affiliation: Medical Department, Mundipharma Pharmaceuticals, Madrid, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Collar
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D000069461:Bendamustine Hydrochloride / Q000191:economics* / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003520:Cyclophosphamide / Q000191:economics / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000191:economics / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000191:economics; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D008390:Markov Chains; D011241:Prednisone / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D000069283:Rituximab / Q000191:economics* / Q000627:therapeutic use; D013030:Spain / Q000453:epidemiology; D014750:Vincristine / Q000191:economics / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000069461:Bendamustine Hydrochloride; D011241:Prednisone