R-CHOP vs. CHOP: A Cost-Effectiveness Analysis on Aggressive Non-Hodgkin's Lymphoma (NHL)

Abstract

The CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisone) is the standard treatment for younger and elderly patients with diffuse large-B-cell lymphoma, but it induces complete responses in only 40 to 50 percent of elderly patients. The benefit of adding Rituximab (R) – a chimeric anti-CD20 IgG1 monoclonal antibody, to CHOP was observed among patients with relatively low risk disease or high risk disease. In comparative studies of CHOP and R-CHOP, the rate of complete response was significantly higher in the group that received R-CHOP than in the group that received CHOP alone. In several EU countries there are cost-effectiveness studies regarding the treatment of aggressive NHL with CHOP vs. R-CHOP, but in Romania there is no such a study done. The authors used a cost-effectiveness model where they compared the costs of both type of treatments and the benefits expressed in gained years of life, in order to have the Romanian perspective for the economic evaluation of treatment of aggressive NHL with CHOP vs. R-CHOP. The Romanian cost-effectiveness analysis is based on a model developed by Best et al. which calculates the cost-effectiveness ratio of R-CHOP vs. CHOP over time horizon of 10 years for patients with diffuse large B-cell lymphoma DLCL. The analysis was done based on local Romanian costs and the clinical benefits from the GELA study. Rituximab administered together with CHOP gives patients an increased chance of cure, a significantly superior survival and represents a cost-effective therapy compared to standard treatment with CHOP. When costs and survival benefits are considered over 10 years, the additional cost per patient on R-CHOP is 12,929 Euro. Over a 10 years time frame, the estimated survival benefit of R-CHOP compared to standard CHOP treatment alone in this group of patients is on average 0.60 extra years of life gained per patient. The estimated additional cost per extra year of life gained for the combination therapy is 21,549 Euro. Using the same cost-effectiveness model we observed that using R-CHOP vs. CHOP we obtained in Romania the lowest cost per additional year of life gained compared with France or United Kingdom. Keywords: cost-effectiveness analysis, cost per life year gained, NHL non-Hodgkin lymphoma