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Cost-effectiveness analysis of rituximab combined with CHOP for treatment of diffuse large B-cell lymphoma

Lookup NU author(s): Professor Stephen Proctor

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Abstract

Purpose: To estimate the cost-effectiveness from a French payer perspective of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) alone compared with CHOP plus rituximab (R-CHOP) for treatment of patients with diffuse large B-cell lymphoma. Methods: Mean patient survival, days of hospitalization, and chemotherapy costs during treatment were estimated from a Phase III trial in France, Belgium, and Switzerland. Survival during the trial was estimated using the Kaplan-Meier method; survival beyond the trial period was projected based on mortality rates from the Scottish and Newcastle Lymphoma Group database. French diagnosis-related group (DRG) payment schedules were applied to trial data to estimate cost of adverse events and drug administration. We estimated survival and cost-effectiveness [the incremental cost per quality-adjusted life-year (QALY) gained] from 4 years (median clinical trial follow-up period) to 15 years, discounted at a fixed annual rate of 3%. We used published patient preferences. We converted currency to euros, based on 2003 exchange rates. Results: R-CHOP resulted in a 20.6% relative increase in complete response rate (absolute increase from 63% to 76%), and a 31% decrease in risk of death at 4 years (95% CI 8-49%). Over a 15-year time horizon, mean overall survival (OS) duration was estimated to be 6.90 years for R-CHOP and 5.74 years for CHOP, a mean increase in OS of 1.16 years (or 1.07 QALYs). Total direct medical costs were 13,170 higher with R-CHOP, with an incremental cost-effectiveness ratio of 12,259 per QALY gained. Conclusion: R-CHOP significantly increases mean OS up to 4 years compared with CHOP, and its cost-effectiveness ratio compares favorably with other oncology treatments in widespread use.

Publication metadata

Author(s): Best, J. H., Hornberger, J., Proctor, S. J., Omnes, L. F., Jost, F.

Publication type: Article

Publication status: Published

Journal: Value in Health

Year: 2005

Volume: 8

Issue: 4

Pages: 462-470

ISSN (print): 1098-3015

ISSN (electronic): 1524-4733

URL: http://dx.doi.org/10.1111/j.1524-4733.2005.00037.x

DOI: 10.1111/j.1524-4733.2005.00037.x

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