A cost-effectiveness analysis of DA-EPOCH-R versus R-CHOP for the treatment of diffuse large B-cell lymphoma.

Abstract

e19018 Background: Clinical trials have indicated that dose adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin and rituximab (DA-EPOCH-R) may improve clinical outcomes when compared to standard rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) treatment in diffuse large B-cell lymphoma (DLBCL). The cost-effectiveness of the newer regimen, DA-EPOCH-R when compared to R-CHOP has not been assessed. Methods: Patients who received either DA-EPOCH-R or R-CHOP treatment at the Bon Secours Hospital from 2008-2016 for DLBCL were identified. The overall survival (OS), progression free survival (PFS) and event free survival (EFS) was determined for each treatment group using Kaplan-Meier survival estimation curves. Direct costs per treatment for each regimen were obtained from public hospital sources. Results: 71 patients were identified, 40 received DA-EPOCH-R, 31 received R-CHOP therapy. The DA-EPOCH-R group had a mean age at diagnosis of 62 years and a higher overall proportion under 70 years old (70%). The mean age for R-CHOP patients was 66 years and the patient age was largely equal for above and below 70 years at diagnosis. The majority of DA-EPOCH-R patients (77.5%) were stage III or higher at diagnosis compared to approximately half of R-CHOP patients (48.4%). Using a 6-year time horizon, there was no significant difference in Kaplan-Meier survival estimates between the two treatment groups for OS (p=0.58), PFS (p=0.48) or EFS (p=0.23). DA-EPOCH-R was found to be a more expensive treatment option in terms of total drug costs and hospital stay costs. Conclusions: DA-EPOCH-R was shown to have no significant difference in OS, PFS and EFS when compared to standard R-CHOP treatment overall in this population yet it is a significantly more expensive treatment option. The results of this study have not shown an economic or clinical advantage to the use of DA-EPOCH-R. It would be of interest to investigate this question in other high grade lymphomas.