Cost-Effectiveness Model for Chemoimmunotherapy Options in Patients with Previously Untreated Chronic Lymphocytic Leukemia Unsuitable for Full-Dose Fludarabine-Based Therapy.
OBJECTIVE
To evaluate the cost-effectiveness of treatment with anti-CD20 monoclonal antibody obinutuzumab plus chlorambucil (GClb) in untreated patients with chronic lymphocytic leukemia unsuitable for full-dose fludarabine-based therapy.


METHODS
A Markov model was used to assess the cost-effectiveness of GClb versus other chemoimmunotherapy options. The model comprised three mutually exclusive health states: "progression-free survival (with/without therapy)", "progression (refractory/relapsed lines)", and "death". Each state was assigned a health utility value representing patients' quality of life and a specific cost value. Comparisons between GClb and rituximab plus chlorambucil or only chlorambucil were performed using patient-level clinical trial data; other comparisons were performed via a network meta-analysis using information gathered in a systematic literature review. To support the model, a utility elicitation study was conducted from the perspective of the UK National Health Service.


RESULTS
There was good agreement between the model-predicted progression-free and overall survival and that from the CLL11 trial. On incorporating data from the indirect treatment comparisons, it was found that GClb was cost-effective with a range of incremental cost-effectiveness ratios below a threshold of £30,000 per quality-adjusted life-year gained, and remained so during deterministic and probabilistic sensitivity analyses under various scenarios.


CONCLUSIONS
GClb was estimated to increase both quality-adjusted life expectancy and treatment costs compared with several commonly used therapies, with incremental cost-effectiveness ratios below commonly referenced UK thresholds. This article offers a real example of how to combine direct and indirect evidence in a cost-effectiveness analysis of oncology drugs.
F. Hoffmann-La Roche Ltd., Basel, Switzerland. Electronic address: ursula.becker@roche.com.
Ursula
U
Becker
Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Andrew H
AH
Briggs
F. Hoffmann-La Roche Ltd., Basel, Switzerland.
Santiago G
SG
Moreno
F. Hoffmann-La Roche Ltd., Basel, Switzerland.
Joshua A
JA
Ray
Roche Products Pty Ltd., Dee Why, New South Wales, Australia.
Phuong
P
Ngo
Genentech, a member of the Roche Group, South San Francisco, CA, USA.
Kunal
K
Samanta
D000368:Aged; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D002699:Chlorambucil / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007167:Immunotherapy; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D008390:Markov Chains; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom; D014740:Vidarabine / Q000031:analogs & derivatives
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D002699:Chlorambucil; D014740:Vidarabine; C543332:obinutuzumab; C024352:fludarabine
chronic lymphocytic leukemia; cost-effectiveness; obinutuzumab; rituximab