PCN102 - Cost-Effectiveness Analysis of Bendamustine-Rituximab Treatment Compared with Fludarabine-Rituximab Treatment, in Patients with Indolent Non-Hodgkin’s Lymphoma in Costa Rica

Abstract

To assess the cost-effectiveness of Bendamustine-Rituximab (BR) compared with Fludarabine-Rituximab (FR) treatment, in patients with Indolent Non-Hodgkin’s Lymphoma (INHL) that have progressed during or within six months of treatment with Rituximab or a Rituximab-containing Regimen in Costa Rica. A three-health state cohort simulation Markov Model (progression-free, progressive disease, and death) was developed based on time-dependent progression-free survival and overall survival data. The time frame was lifetime (35 years). The perspective was that of the National Health System of Costa Rica. The health outcomes of interest were Quality Adjusted Life Years (QALYs), Life Years (LYs), and Progression-free Life Years (PFLYs). Resource consumption for health states was elicited with the support of Latin American hematologists. Utilities for health states and disutility for adverse reactions were taken from published studies. All costs and Incremental Cost Effectiveness Ratios (ICERs) are presented in Costa Rican currency (Colones). Costs and outcomes were discounted at 3%. One way and probabilistic sensitivity (PSA) analysis were performed. BR resulted in 4,641 QALYs/ 6,432 LYs/ and 3,564 PFLYs, per patient, respectively. FR resulted in 3,557 QALYs/5,138 LYs and 2,047 PFLYs, per patient, respectively. Total costs were: 76.309.813 for BR and 73.045.490 for FR. ICERs were: 3.013.664 per QALY gained, 2.523.307 per LY gained and 2.151.945 per PFLY gained. In all outcomes, results were highly sensitive to Hazard Ratio of overall survival. According to the PSA, with QALYs as outcome, BR had a probability of 63% of being cost effective when considering the threshold of 3 times the Gross Domestic Product per capita (GDPPC) of Costa Rica (14.140.792). BR can be considered very cost-effective compared with FR in the study population (INHL) in Costa Rica, according to the threshold suggested by the World Health Organization [very cost effective below 1 GDPPC (4.713.597)].