PCN94 - The Cost-Effectiveness of Bendamustine-Rituximab Versus Fludarabine-Rituximab for Patients with Indolent Non-Hodgkin’s Lymphoma (INHL) Who Have Progressed Following Treatment with Rituximab or a Rituximab-Containing Regimen in Colombia

Abstract

To determine the cost-effectiveness of bendamustine-rituximab (Ben-R) versus fludarabine-rituximab (Fdb-R) in patients with iNHL who have progressed following treatment with rituximab or a rituximab-containing regimen in Colombia. An economic model was constructed from the Colombian health system perspective, with a 35-year (lifetime) horizon and a discount rate of 3%. The model included three health states, progression-free (PF), progressive disease (PD), and death, which were associated with utility weights of 0.81, 0.62 and 0, respectively. Clinical inputs (response rates, Kaplan-Meier curves, hazard ratios (HRs) and adverse event rates) were from the Stil NHL 2-2003 study. Resource use data were from interviews with three Colombian hematologists treating iNHL patients. Unit costs were from ISS and SISPRO report and were expressed as 2013 Colombian Pesos. Univariate and probabilistic sensitivity analyses were conducted to determine the key drivers of cost-effectiveness, and uncertainty around the results, respectively. Total lifetime cost of Ben-R was $291,192,912 and total cost of Fdb-R was $260,463,392. Ben-R patients accrued more LYs (6.47 vs. 5.15), QALYs (4.66 vs. 3.56), and PFLYs (3.57 vs. 2.05) compared to Fdb-R patients. The ICERs were $23,286,360 (cost per LY), $27,956,124 (cost per QALY) and $20,259,063 (cost per PF LY). Univariate sensitivity analysis revealed that the ICER per LY was most sensitive to the PFS and OS HRs for Ben-R vs Fdb-R, the number of treatment cycles, and the cost of bendamustine. Probabilistic sensitivity analysis with 1,000 iterations estimated that Ben-R had a 52% chance of being cost-effective, compared to Fdb-R, at a willingness to pay (WTP) of $59M per LY, rising to a plateau of about 93% at a WTP of $175M and above. At a willingness-to-pay of $59M (three times the GDP per capita of Colombia) Ben-R is a cost-effective alternative to Fdb-R.