Economic burden of relapsed/refractory diffuse large B-cell non-Hodgkin's lymphoma (DLBCL): A review of the literature.

Abstract

e18564 Background: The addition of rituximab to standard CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) has been shown to be cost-effective. With demonstrated clinical efficacy, it is standard first-line treatment for DLBCL. Treatment for relapsed/refractory (R/R) DLBCL is less clear, and we sought to assess its economic impact. Methods: A structured literature review was performed to assess the economic, clinical, and patient burden of R/R DLBCL. English-language articles published between 01/1999 and 06/2009 were systematically reviewed in Medline PubMed and the Cochrane database. Articles were considered relevant to economic burden if they reported resource utilization and/or costs associated with treatment for R/R DLBCL. Results: Of 127 articles identified on NHL, 18 addressed economic outcomes. While articles focusing on first-line comparisons included aggregate estimates of additional treatment costs, detailed cost and resource utilization estimates were not identified in the R/R setting. While it is clear from the literature that the economic burden of DLBCL is substantial, rigorous economic analyses have not been reported in the R/R population and no economic analyses were identified that examined the treatment costs for R/R DLBCL. One retrospective analysis examining costs of aggressive NHL (not DLBCL specifically) associated with treatment from a US-perspective reported that treatment failure was the most costly outcome with a mean monthly cost of $14,174; however, costs were not specific to individual regimens. Two studies (from a Canadian and Netherlands perspective each) were identified that provided general (not treatment-specific) resource utilization and cost estimates for R/R treatment. Conclusions: As there is no clear standard treatment for R/R DLBCL, economic comparisons between treatment alternatives may provide selection guidance in situations in which clinical efficacy is considered equivalent. Published literature has not robustly examined treatment options and their relative cost-effectiveness, and more research is needed to define the economic burden associated with the treatment of R/R DLBCL. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration MedImmune, LLC MedImmune, LLC AstraZeneca