Rituximab Cost Analysis for Maintenance Treatment of Patients With Follicular Lymphoma

Abstract

IntroductionIn patients with refractory or recurrent follicular lymphoma responding to induction therapy with CHOP or rituximab + CHOP, maintenance treatment with rituximab compared to the “observation” option improves both overall survival and progression-free survival. ObjectiveEstimate whether maintenance treatment with rituximab is a cost-effective intervention compared to the clinical practice of “observing” its evolution. MethodPopulation: the EORTC 20981 clinical trial population. Perspective: Spanish National Health System (direct healthcare costs). Design: Incremental cost-effectiveness analysis, with a transition model between states of health. Main variables: cost of gaining a quality-adjusted life year (QALY), per life year gained (LYG) and per progression-free LYG. Premises of the basic case: Weibull distribution for survival extrapolation, 5 year duration of the benefits of the treatment, time horizon of 10 years, and annual discount rate (costs and benefits) of 3.5%. These premises were modified in the sensitivity analyses. ResultsDeterministic analysis: the cost per QALY gained was €9358, €8493 per LYG, and €5485 per progression-free LYG. Probabilistic and sensitivity analysis: they confirmed the stability of the deterministic analysis results. ConclusionsAccording to this model, maintenance treatment with rituximab is cost-effective (cost per LYG <€30 000) in patients with resistant or recurrent follicular lymphoma responding to induction treatment, in comparison to the usual practice of observing patients’ evolution.