title: Cost-effectiveness analysis of bortezomib in combination with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (VR-CAP) in patients with previously untreated mantle cell lymphoma.
abstract: Mantle cell lymphoma (MCL) is a rare and aggressive form of non-Hodgkin's lymphoma. Bortezomib is the first product to be approved for the treatment of patients with previously untreated MCL, for whom haematopoietic stem cell transplantation is unsuitable, and is used in combination with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (VR-CAP). The National Institute of Health and Care Excellence recently recommended the use of VR-CAP in the UK following a technology appraisal. We present the cost effectiveness analysis performed as part of that assessment: VR-CAP versus the current standard of care regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) in a UK setting.
  
  
  
  A lifetime economic model was developed with health states based upon line of treatment and progression status. Baseline patient characteristics, dosing, safety and efficacy were based on the LYM-3002 trial. As overall survival data were immature, survival was modelled by progression status, and post-progression survival was assumed equal across arms. Utilities were derived from LYM-3002 and literature, and standard UK cost sources were used.
  
  
  
  Treatment with VR-CAP compared to R-CHOP gave an incremental quality-adjusted life year (QALY) gain of 0.81 at an additional cost of £16,212, resulting in a base case incremental cost-effectiveness ratio of £20,043. Deterministic and probabilistic sensitivity analyses showed that treatment with VR-CAP was cost effective at conventional willingness-to-pay thresholds (£20,000-£30,000 per QALY).
  
  
  
  VR-CAP is a cost-effective option for previously untreated patients with MCL in the UK.
authors.affiliation: BresMed, Arthur van Schendelstraat 650, 3511MJ, Utrecht, The Netherlands. mvankeep@bresmed.co.uk.
authors.forename: Marjolijn
authors.identifier: 0000-0002-2418-660X
authors.initials: M
authors.lastname: van Keep
authors.affiliation: Janssen-Cilag, 50-100 Holmers Farm Way, High Wycombe, HP12 4EG, UK.
authors.forename: Kerry
authors.initials: K
authors.lastname: Gairy
authors.affiliation: Janssen-Cilag, Johnson & Johnson Platz 1, 41470, Neuss, Germany.
authors.forename: Divyagiri
authors.initials: D
authors.lastname: Seshagiri
authors.affiliation: Janssen-Cilag, Turnhoutseweg 30, B-2340, Beerse, Belgium.
authors.forename: Pushpike
authors.initials: P
authors.lastname: Thilakarathne
authors.affiliation: BresMed, 84 Queen Street, Sheffield, S1 2DW, UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Lee
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D000069286:Bortezomib / Q000008:administration & dosage* / Q000191:economics*; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D019057:Quality-Adjusted Life Years; D000069283:Rituximab / Q000008:administration & dosage; D006113:United Kingdom; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000069283:Rituximab; D014750:Vincristine; D000069286:Bortezomib; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Bortezomib; Cost effectiveness; Mantle cell lymphoma; R-CHOP; VR-CAP