title: Cost-effectiveness of obinutuzumab for chronic lymphocytic leukaemia in The Netherlands.
abstract: Obinutuzumab combined with chlorambucil (GClb) has shown to be superior to rituximab combined with chlorambucil (RClb) and chlorambucil (Clb) in newly diagnosed patients with chronic lymphocytic leukaemia (CLL). This study evaluates the cost-effectiveness per life-year and quality-adjusted life-year (QALY) of GClb compared to RClb, Clb, and ofatumumab plus chlorambucil (OClb) in The Netherlands.
  
  
  
  A Markov model was developed to assess the cost-effectiveness of GClb, RClb, Clb and other treatments in the United Kingdom. A country adaptation was made to estimate the cost-effectiveness of these therapies in The Netherlands using Dutch unit costs and Dutch data sources for background mortality and post-progression survival.
  
  
  
  An incremental gain of 1.06 and 0.64 QALYs was estimated for GClb compared to Clb and RClb respectively, at additional costs of €23,208 and €7254 per patient. Corresponding incremental cost-effectiveness ratios (ICERs) were €21,823 and €11,344 per QALY. Indirect treatment comparisons showed an incremental gain varying from 0.44 to 0.77 QALYs for GClb compared to OClb and additional costs varying from €7041 to €5028 per patient. The ICER varied from €6556 to €16,180 per QALY. Sensitivity analyses showed the robustness of the results.
  
  
  
  GClb appeared to be a cost-effective treatment strategy compared to RClb, OClb and Clb.
authors.affiliation: Institute for Medical Technology Assessment, Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Netherlands Comprehensive Cancer Organisation, Netherlands Cancer Registry Utrecht, The Netherlands. Electronic address: blommestein@bmg.eur.nl.
authors.forename: Hedwig M
authors.initials: HM
authors.lastname: Blommestein
authors.affiliation: Institute for Medical Technology Assessment, Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: de Groot
authors.affiliation: Netherlands Comprehensive Cancer Organisation, Netherlands Cancer Registry Utrecht, The Netherlands.
authors.forename: Mieke J
authors.initials: MJ
authors.lastname: Aarts
authors.affiliation: University of Groningen, Pharmacotherapy, -Epidemiology, -Economics (PTE2), Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands.
authors.forename: Pepijn
authors.initials: P
authors.lastname: Vemer
authors.affiliation: Roche Nederland B.V., Health Economics and Business Development, Woerden, The Netherlands.
authors.forename: Robin
authors.initials: R
authors.lastname: de Vries
authors.affiliation: Roche Nederland B.V., Health Economics and Business Development, Woerden, The Netherlands.
authors.forename: Annet F M
authors.initials: AF
authors.lastname: van Abeelen
authors.affiliation: Department of Internal Medicine, Reinier de Graaf Group, Delft, The Netherlands.
authors.forename: E F M Ward
authors.initials: EF
authors.lastname: Posthuma
authors.affiliation: Institute for Medical Technology Assessment, Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Netherlands Comprehensive Cancer Organisation, Netherlands Cancer Registry Utrecht, The Netherlands.
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
mesh_terms: 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 / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000379:methods*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000191:economics; D008390:Markov Chains; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D000069283:Rituximab / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D002699:Chlorambucil; D000069283:Rituximab; C543332:obinutuzumab
keywords: Chlorambucil; Chronic lymphocytic leukaemia; Cost-effectiveness; Costs; Obinutuzumab; Ofatumumab; Rituximab