Abstract
ObjectivesTo use real-world data to develop a flexible generic decision model to predict cost, life expectancy, and quality-adjusted life-years (QALYs) for follicular lymphoma (FL) in the general patient population. MethodsAll patients newly diagnosed with FL in the UK’s population-based Haematological Malignancy Research Network (www.hmrn.org) between 2004 and 2011 were followed until 2015 (N = 740). Treatment pathways, QALYs, and costs were incorporated into a discrete event simulation to reflect patient heterogeneity, including age and disease management. Two scenario analyses, based on the latest National Institute for Health and Clinical Excellence (NICE) guidelines (rituximab induction therapy for newly diagnosed asymptomatic patients and rituximab maintenance therapy for patients between treatments), were conducted and their economic impacts were compared to current practice. ResultsIncidence-based analysis revealed expected average lifetime costs ranging from £6,165 [US$7,709] to £63,864 [US$79,862] per patient, and average life expectancy from 75 days to 17.56 years. Prevalence-based analysis estimated average annual treatment costs of £60–65 million [US$75-80 million], accounting for approximately 10% of the United Kingdom’s annual National Health Service budget for hematological cancers as a whole. Assuming that treatment effects reported in trials are applicable to all patient groups, scenario analyses for two recent NICE guidelines demonstrated potential annual cost savings for the United Kingdom that ranged with uptake frequency from £0.6 million to £11 million [US$0.75-2.75 million]. ConclusionsCosts, survival, and QALYs associated with FL vary markedly with patient characteristics and disease management. Allowing the production of more realistic outcomes across the patient population as a whole, our model addresses this heterogeneity and is a useful tool with which to evaluate new technologies/treatments to support healthcare decision makers.
Highlights
Accounting for approximately 20% of all non-Hodgkin lymphomas (NHLs), approximately 1860 patients are newly diagnosed with follicular lymphoma (FL) each year in the United Kingdom [1,2,3]
Costs, survival, and quality-adjusted life-years (QALYs) associated with FL vary markedly with patient characteristics and disease management
Key to the present report is the fact that HMRN has Section 251 support under the NHS Act 2006, which allows full-treatment, response, and outcome data to be collected to clinical trial standards regardless of patient consent, as well as “flagging” for death at the national Medical Research Information Service (MRIS) and linkage to nationwide information on Hospital Episode Statistics (HES)
Summary
Accounting for approximately 20% of all non-Hodgkin lymphomas (NHLs), approximately 1860 patients are newly diagnosed with follicular lymphoma (FL) each year in the United Kingdom [1,2,3]. FL, the most common of the indolent NHLs, typically follows a remitting relapsing course; initial management ranges from “watch-and-wait (W&W)” (active monitoring/observation) to immediate treatment with chemotherapy/radiotherapy or palliative care. Therapy is given in response to symptoms, with some patients having several lines of treatment while others remain on W&W. Instead of simple W&W, the use of rituximab induction therapy as a strategy to delay the need for chemotherapy/radiotherapy has been recommended and adopted as a treatment option in newly diagnosed asymptomatic patients with advanced stage disease [4].
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