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.

CONCLUSION:

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: Eliazar Sabater, Armando López-Guillermo, Antonio Rueda, Antonio Salar, Itziar Oyagüez, Juan Manuel Collar
• Journal: Applied health economics and health policy (Appl Health Econ Health Policy) Vol. 14 Issue 4 Pg. 465-477 (Aug 2016) ISSN: 1179-1896 [Electronic] New Zealand
• PMID: 27090915 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Agents
• Antineoplastic Agents, Alkylating
• R-CHOP protocol
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Bendamustine Hydrochloride
• Prednisone

Topics

• Antibodies, Monoclonal, Murine-Derived (economics, therapeutic use)
• Antineoplastic Agents (economics, therapeutic use)
• Antineoplastic Agents, Alkylating (economics, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (economics, therapeutic use)
• Bendamustine Hydrochloride (economics, therapeutic use)
• Costs and Cost Analysis
• Cyclophosphamide (economics, therapeutic use)
• Disease-Free Survival
• Doxorubicin (economics, therapeutic use)
• Drug Therapy, Combination (economics)
• Humans
• Lymphoma, Follicular (drug therapy, economics, mortality)
• Markov Chains
• Prednisone (economics, therapeutic use)
• Quality-Adjusted Life Years
• Rituximab (economics, therapeutic use)
• Spain (epidemiology)
• Vincristine (economics, therapeutic use)