A cost-effectiveness analysis of front-line treatment strategies in early-stage follicular lymphoma

AbstractRecent data suggests the use of radiotherapy alone (RT) in Early-Stage Follicular Lymphoma is declining. Cost-effectiveness analysis of treatments has not been performed. We constructed a partitioning model (15-year horizon) to compare RT, combined-modality therapy (CMT) and immunochemotherapy with rituximab maintenance (ICT+RM) from a PET-staged cohort from the Australian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. AUD $75,000 was defined as the willingness-to-pay threshold (WTP). The direct healthcare costs were: RT $12,791, CMT $29,391 and ICT+RM $42,644. Compared with RT, CMT demonstrated minimal improvement in QALYs (+0.01) and an ICER well above the WTP threshold ($1,535,488). Compared with RT, ICT+RM demonstrated an improvement in QALYs (+0.41) with an ICER of $73,319. Modelling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions with ICT+RM ($52,476). ICT+RM is cost-effective in early stage FL from the Australian taxpayer perspective.

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Cost-Effectiveness Analysis of Prophylaxis Treatment Strategies to Reduce the Incidence of Febrile Neutropenia in Patients with Early-Stage Breast Cancer or Non-Hodgkin Lymphoma

PharmacoEconomics ◽

10.1007/s40273-016-0474-0 ◽

2016 ◽

Vol 35 (4) ◽

pp. 425-438 ◽

Cited By ~ 8

Author(s):

Kelly Fust ◽

Xiaoyan Li ◽

Michael Maschio ◽

Guillermo Villa ◽

Anju Parthan ◽

...

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Febrile Neutropenia ◽

Hodgkin Lymphoma ◽

Early Stage ◽

Treatment Strategies ◽

Cost Effectiveness Analysis ◽

Early Stage Breast Cancer ◽

Non Hodgkin Lymphoma ◽

Effectiveness Analysis

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Cost-effectiveness analysis of first-line treatments for early-stage, low-grade follicular lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6619 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6619-6619 ◽

Cited By ~ 1

Author(s):

Joanna C. Yang ◽

Elena B. Elkin ◽

Rahul Parikh ◽

Joachim Yahalom

Keyword(s):

Cost Effectiveness ◽

Follicular Lymphoma ◽

Early Stage ◽

Complete Response ◽

Cost Effectiveness Analysis ◽

Low Grade ◽

First Line ◽

Effectiveness Analysis ◽

Cost Effective Treatment ◽

Quality Adjusted Life

6619 Background: Low-grade follicular lymphoma (FL) can present as localized stage I to II disease in up to one-third of patients. Upfront involved-site radiation therapy (RT) to 24-30Gy is the preferred first-line management strategy for these patients. However, the National LymphoCare Study found that less than one quarter of patients with early-stage, low-grade FL received upfront RT, while more than half received either chemoimmunotherapy or observation. Methods: We performed a cost-effectiveness analysis using a Markov state-transition model to simulate the progression of early-stage, low-grade FL in a cohort of 60-year-old men. The following first-line treatments were compared: RT, observation, rituximab induction (RI), rituximab and bendamustine (BR), and rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP). Patients who relapsed received second-line therapies that were dependent on their first-line treatment: RT for RI and observation, RCHOP for RT and BR, and BR for RCHOP. Disease-progression probabilities and other model inputs were from published trials. Results: First-line RT followed by RCHOP for relapses had a quality-adjusted life expectancy (QALE) of 11.4 years, superior to first-line observation, RI, BR, and RCHOP strategies. First-line RT strongly dominated observation, BR, and RCHOP. Compared with RI, first-line RT resulted in an incremental cost-effectiveness ratio of $2,740 per quality-adjusted life year. The probability of dying from other causes, the probability of a complete response to RT, and the probability of relapse had the greatest impact on both cost and effectiveness expected values. Conclusions: In contrast to current practice patterns, first-line RT is the most effective upfront treatment for patients with early-stage, low-grade FL. Further, first-line RT paired with RCHOP for relapses is a cost-effective treatment paradigm, relative to other strategies. [Table: see text]

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