Cost-Effectiveness of Rituximab Maintenance Treatment Versus Autologous Stem Cell Transplantation (ASCT) in Patients with Relapsed Follicular Lymphoma (FL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3337-3337 ◽  
Author(s):  
Sirpa Leppä ◽  
Miika Linna ◽  
Heidi Nyman ◽  
Eeva Taimela
Keyword(s):  
Cost Effectiveness ◽  
Patient Population ◽  
Maintenance Treatment ◽  
University Hospital ◽  
Base Case ◽  
High Dose ◽  
Efficacy Data ◽  
Rituximab Maintenance ◽  
Early Results ◽  
First Relapse

Abstract PURPOSE: High dose chemotherapy followed by ASCT is commonly used in responding patients with FL as consolidation treatment in first relapse. Recently, rituximab maintenance treatment has shown to improve both progression free (PFS) and overall survival (OS) in the same patient population. The objective of this analysis was to estimate the incremental cost-effectiveness of rituximab maintenance compared to ASCT in patients with FL in first relapse. METHODS: Efficacy data for rituximab maintenance treatment was derived from the EORTC 20981 trial (van Oers et al, ASH 2005). FL patients (n=334) were randomized to observation or rituximab maintenance treatment in first relapse. Rituximab maintenance treatment consisted of eight infusions during two years. The reported PFS for R-CHOP induction followed by maintenance arm was 51.9 mo, in comparison to 23.1 mo for observation arm. Efficacy data on ASCT and immunochemotherapy were derived from local experience during 1994–2005. Twelve patients with relapsed FL received ASCT, and had median PFS of 34.1 mo. In comparison, fifty patients who received immunochemotherapy without neither ASCT nor rituximab maintenance had a PFS of 21.8 mo, which is comparable to the outcome of R-CHOP treated patients in the observation arm of the EORTC 20981 study. To estimate the incremental resources involved we included therapy associated costs, and visit costs during the first two years. Rituximab maintenance costs included eight infusion visits, in addition to drug costs. Costs for ASCT were based on real data of individual patients, collected from hospital’s accounting systems. These costs are also used as prices charged by Helsinki University Hospital (HUCH) in Finland. The costs included only direct medical costs for hospital services and were calculated in 2004 prices. RESULTS: The cost of rituximab maintenance treatment was estimated to be approximately EUR 19.700. The actual cost of ASCT was approximately EUR 38.600. In terms of health benefits, rituximab maintenance seems to provide longer PFS after first relapse, with incremental difference of 17.8 mo, based on these early results reported. In the base case, therapy associated costs were lower in the rituximab maintenance treatment group. After sensitivity analysis without follow-up visit costs, this difference remained. Thus, rituximab maintenance treatment was the dominant choice in treating FL patients at first relapse, when compared to ASCT. CONCLUSIONS: This analysis cloncludes that new treatment approaches may lead to improved PFS combined with cost savings in those FL patients where ASCT previously has been the preferred treatment option. The potential impact of these findings on the whole FL patient population will be discussed.

Cost-effectiveness of rituximab maintenance therapy for patients with follicular lymphoma: The Spanish perspective

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8092-8092
Author(s):  
J. Gómez Codina ◽  
M. Provencio ◽  
A. Rueda ◽  
F. Capote ◽  
F. Carbonell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Maintenance Therapy ◽  
Follicular Lymphoma ◽  
Maintenance Treatment ◽  
Progression Free Survival ◽  
Base Case ◽  
Health States ◽  
Free Survival ◽  
Rituximab Maintenance ◽  
Life Years

8092 Background: In patients with relapsed or refractory follicular lymphoma (FL) who attain a response with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone or Rituximab + CHOP, maintenance treatment with Rituximab has shown to significantly improve overall survival (OS) (85% at 3 years vs. 77%, p=0.011) and progression free survival (PFS) (51,5 vs. 14.9 months, p<0.001) as compared to observation alone (OA). We analyzed the cost-effectiveness, from a Spanish perspective, of Rituximab maintenance therapy (375mg/m2 every 3 months until progression or for 2 years) versus OA according to the population and data described for the European Organization for Research Treatment of Cancer (EORTC) 20981 study (van Oers MHJ Blood 2006). Methods: Incremental cost-effectiveness was assessed through a deterministic, three health states model (disease-free, progression and death) transition model. Base case model: PFS and OS were extrapolated from EORTC 20981 data using a Weibull distribution, Rituximab maintenance benefit was assumed to last 5 years, 10 years time horizon, 3.5% discount rate on costs and benefits, and Spanish National Health Service perspective (direct costs only). Resource use was estimated from a Spanish expert panel and EORTC 20981 study. Unit costs were obtained from local databases (May 2006 €). Health states utility values were derived from an ad hoc study. Sensitivity analyses were performed for all mentioned variables. Results: For the base case, more quality-adjusted life years (QALY), life-years (LY) and progression-free survival years per patient on maintenance therapy were obtained versus OA (incremental values of 0.85, 0.94 and 1.46, respectively). Total cost per patient was higher with Rituximab than with OA (+8,026€). Incremental cost per QALY gained was 9,358€, with a cost per LY gained of 8.493€ and a cost per PFS year gained of 5,485€. In the sensitivity analysis, values ranged between 7.263€ and 22.160€ per QALY gained. Conclusions: This study confirms that in patients with relapsed /refractory FL who attain a response with further therapy, maintenance treatment with Rituximab compared to observation alone is cost-effective. No significant financial relationships to disclose.

scholarly journals Chemotherapy-based versus chemotherapy-free stem cell mobilization (± plerixafor) in multiple myeloma patients: an Italian cost-effectiveness analysis

2021 ◽  
Author(s):  
Carlo Lazzaro ◽  
Luca Castagna ◽  
Francesco Lanza ◽  
Daniele Laszlo ◽  
Giuseppe Milone ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cost Effectiveness ◽  
Cost Effectiveness Analysis ◽  
Hematopoietic Progenitor Cell ◽  
Base Case ◽  
High Dose ◽  
On Demand ◽  
Effectiveness Analysis ◽  
Cell Mobilization ◽  
The Cost

AbstractGiven the availability and efficacy of the mobilizing agent plerixafor in augmenting hematopoietic progenitor cell mobilization with granulocyte colony-stimulating factor (G-CSF), there is a strong case for comparing the cost-effectiveness of mobilization with G-CSF + cyclophosphamide versus G-CSF alone. This study investigated the cost and effectiveness (i.e., successful 4 million-CD34+ collection) of G-CSF alone versus high-dose cyclophosphamide (4 g/m2) + G-CSF mobilization (± on-demand plerixafor) in patients with multiple myeloma (MM) eligible for autograft in Italy. A decision tree-supported cost-effectiveness analysis (CEA) model in MM patients was developed from the societal perspective. The CEA model compared G-CSF alone with cyclophosphamide 4 g/m2 + G-CSF (± on-demand plerixafor) and was populated with demographic, healthcare and non-healthcare resource utilization data collected from a questionnaire administered to six Italian oncohematologists. Costs were expressed in Euro (€) 2019. The CEA model showed that G-CSF alone was strongly dominant versus cyclophosphamide + G-CSF ( ± on-demand plerixafor), with incremental savings of €1198.59 and an incremental probability of a successful 4 million-CD34+ apheresis (+0.052). Sensitivity analyses confirmed the robustness of the base-case results. In conclusion, chemotherapy-free mobilization (± on-demand plerixafor) is a “good value for money” option for MM patients eligible for autograft.

scholarly journals Analysis of PBAC submissions and outcomes for medicines (2010–2018)

2020 ◽  
Vol 36 (3) ◽  
pp. 224-231
Author(s):  
Sean Lybrand ◽  
Michael Wonder
Keyword(s):  
Cost Effectiveness ◽  
Patient Population ◽  
Rejection Rate ◽  
Mean Value ◽  
New Combination ◽  
Annual Number ◽  
Base Case ◽  
Cost Effectiveness Ratio ◽  
A Minor ◽  
Pharmaceutical Benefits Scheme

ObjectivesThe Pharmaceutical Benefits Scheme (PBS) provides timely, reliable, and affordable access to necessary medicines for Australians. We reviewed the Pharmaceutical Benefits Advisory Committee (PBAC) submissions and their related outcomes and timelines since 2010.MethodsWe examined the PBS Website to identify submissions and their related PBAC outcomes for new medicines, new indications, and new combination products that had been considered by the PBAC since 2010.ResultsThirty-five PBAC meetings were held during the study period, at which the Committee considered 781 submissions (1,074 medicine/patient population pairings). We saw an increase in the annual number of submissions (medicine/patient population parings). The recommendation rate for the study period was higher than the rejection rate. The annual mean value for the period from the date of initial PBAC recommendation to the date of PBS listing ranged from 357 to 644 days; the annual mean value for the period of the date of PBAC recommendation to the date of PBS listing ranged from 187 to 245 days. It took, on average, 1.70 submissions that included an economic evaluation to obtain a PBAC recommendation. It took more submissions to obtain a PBAC recommendation for a cost-effectiveness analysis submission than it did for a CMA submission. The PBAC was willing to recommend medicines for most acceptable base-case incremental cost-effectiveness ratio (ICER) bands, and the majority of the PBAC did not recommended any medicine in the study period that had a base-case ICER >AUD75,000.ConclusionsThe results of our analyses reveal a minor reduction in the period from the date of PBAC recommendation to the date of PBS listing. Several analyses were hampered by a high proportion of missing data.

Relapsed Hodgkin Lymphoma in Elderly Patients: A Comprehensive Analysis From the German Hodgkin Study Group (GHSG)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 92-92 ◽  
Author(s):  
Boris Böll ◽  
Helen Görgen ◽  
Nils Arndt ◽  
Annette Plütschow ◽  
Michael Fuchs ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
Median Survival ◽  
Patient Population ◽  
Comprehensive Analysis ◽  
High Dose ◽  
Study Group ◽  
Line Treatment ◽  
First Relapse ◽  
Relapsed Disease

Abstract Abstract 92 Purpose: About 20% of all patients with Hodgkin Lymphoma (HL) are older than 60 years. They have a poor prognosis and often experience progressive or relapsed disease. To date, very little is known about second-line treatment, side effects and long-term outcome in elderly patients with progressive or relapsed HL. The German Hodgkin Study Group (GHSG) therefore carried out a comprehensive analysis of this interesting patient population. Out of 754 elderly HL patients treated within GHSG studies between 1993 and 2007, we identified those patients with documented disease progression or relapse and updated information on treatment, remission and survival status. Patients and Methods: 115 patients with documented relapse or disease progression and a median observation time of 6 years were identified and included in the analysis. The patients' age at initial diagnosis ranged from 60 to 75 years (median 66 years), and 55% were male. Initially, most patients had mixed cellularity (46%) or nodular sclerosis (40%) subtype of HL. 53% of the patients had advanced stage disease according to the GHSG classification and 35% had not completed first line therapy as planned, mostly due to toxicity or progressive lymphoma (10% each). 27%, 31% and 42% had progressive disease, early and late relapse, respectively, and the median period between first diagnosis and first progression/relapse was 16 months. Results: Half of the patients received a curative treatment for relapsed disease, including conventional chemotherapy (ct) as ABVD or BEACOPP as well as high-dose ct. This approach resulted in CR/CRu in about 55% in this group of patients and median survival after first relapse/progression was two years. Interestingly, the outcome of the subgroup receiving conventional ct regimens was considerably better as compared to patients receiving high-dose ct (2.5 years difference in median survival after first relapse/progression). Palliative treatment, consisting of single-agent ct and/or radiotherapy or no therapy, was applied in about half of the patients. However, in these patients, median survival after first relapse/progression was only six months. Overall, a third line treatment was applied in 37 patients and 12 patients received a fourth treatment. In total, 99 patients died within the observation period (86%, 95%CI 78% to 92%): 63 patients (55%) of HL und 13 patients (11%) of treatment-associated toxicity. Overall, median survival after first relapse/progression was only 11 months in the analyzed group of patients. Conclusion: To our knowledge, this GHSG analysis provides by far the largest set of data published on relapsed/progressive HL of the elderly. In conclusion, the overall prognosis for these patients is very poor since less than 50% of the patients survive one year after relapse/progression. Obviously, there is a great medical need for older patients with relapsed HL. Our results should prompt further investigation and might be used to plan and design studies in this growing patient population. Disclosures: No relevant conflicts of interest to declare.

Cost Effectiveness of Adjuvant Interferon in Node-Positive Melanoma

2007 ◽  
Vol 25 (17) ◽  
pp. 2442-2448 ◽  
Author(s):  
Janice N. Cormier ◽  
Yan Xing ◽  
Meichun Ding ◽  
Scott B. Cantor ◽  
Kristi J. Salter ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Stage Iiib ◽  
Stage Iii ◽  
Base Case ◽  
High Dose ◽  
Stage Iiia ◽  
Stage Iiic ◽  
Old Patients ◽  
Life Years

Purpose To assess the benefits of adjuvant high-dose interferon alfa (HDI) treatment for patients with high-risk melanoma. Methods We designed a decision-analytic probabilistic Markov model to simulate the natural history of patients with stage IIIA, IIIB, and IIIC melanoma and evaluate the outcomes with and without HDI treatment. Outcomes were in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Probability estimates and costs were derived from primary patient level data, while the efficacy of HDI and associated utilities were determined from published reports. The base-case analysis was a cohort of 50-year-old patients. Results HDI increased the median life expectancy in patients with stage III melanoma from 3.75 years in the observation cohort to 4.42 years in the HDI cohort. The difference in QALYs ranged from 0.31 years for stage IIIA patients to 0.60 years for stage IIIC patients treated with HDI. HDI was cost effective in patients with stage IIIB and IIIC melanoma, with ICERs of $95,304 and $76,068 per QALY gained, respectively. Using a threshold of $100,000 per QALY gained, HDI was cost effective for all stage III patients younger than 52 years. HDI was not cost effective for patients with stage IIIA disease and for subsets of patients older than 63 years with stage IIIB disease. Conclusion Our model demonstrates that the probability of HDI being cost effective varies substantially by melanoma substage. HDI showed the greatest benefit in terms of QALYs and was most cost effective in patients younger than 60 years with stage IIIC disease.

Cost-Utility of Tiotropium in Patients With Severe Asthma

2021 ◽  
Author(s):  
Jefferson Antonio Buendia ◽  
Diana Guerrero Patino
Keyword(s):  
Cost Effectiveness ◽  
Severe Asthma ◽  
Standard Therapy ◽  
Inhaled Corticosteroids ◽  
Sensitivity Analyses ◽  
Base Case ◽  
High Dose ◽  
Lifetime Horizon ◽  
Life Years ◽  
The Cost

Abstract BackgroundAn important proportion of asthma patients remain uncontrolled despite the use of inhaled corticosteroids and long-acting beta-agonists. Some add-on therapies, as tiotropium bromide have been recommended for this subgroup of patients. The purpose of this study was to assess the cost-effectiveness of tiotropium as add-on therapies to ICS + LABA for patients with severe asthma. Methods A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Total costs and QALYS of two interventions including standard therapy (ICS + LABA), add-on therapy with tiotropium, were calculated over a lifetime horizon. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. ResultsThe model suggests a potential gain of 1.06 QALYs per patient per year on tiotropium, with a difference of US$ 478 in favor of tiotropium; showing dominance respect to standard therapy. A position of dominance negates the need to calculate an incremental cost‐effectiveness ratio. In the deterministic sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters Conclusion Add-on therapy with tiotropium was found to be cost-effective when added to usual care in patients who remain uncontrolled despite treatment with medium or high-dose ICS/LABA. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

Cost-Effectiveness of Rituximab As Maintenance Treatment for Relapsed Follicular Lymphoma: Results of a Population Based Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4277-4277
Author(s):  
Hedwig M Blommestein ◽  
Djamila E Issa ◽  
Marjolein Pompen ◽  
Cédric Révil ◽  
Mels Hoogendoorn ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Follicular Lymphoma ◽  
Real World ◽  
Maintenance Treatment ◽  
Population Based ◽  
Resource Utilisation ◽  
World Population ◽  
Second Line ◽  
Rituximab Maintenance ◽  
Maintenance Group

Abstract Abstract 4277 OBJECTIVES: Effectiveness of rituximab maintenance treatment among patients with relapsed follicular lymphoma (FL) has been established in a randomised setting (EORTC20981 trial). Although the golden standard, results might not be generalisable to unselected real-world patient populations. Outcomes research was conducted to calculate real-world cost-effectiveness of second line rituximab maintenance compared to observation in FL patients in the Netherlands. METHODS: Two Dutch population-based registries, PHAROS and HemoBase respectively, collected information on patient characteristics, treatment, and resource utilisation on patients diagnosed with FL in the past 20 years. Patients responding to second line chemotherapy were included in the observation or maintenance group. A Markov model was applied to calculate real-world cost-effectiveness. RESULTS: Although 735 FL patients entered the registries, only 57 and 49 patients were eligible and included in the observation and maintenance group, respectively. Median age was 61 years and similar in both groups. Differences between the groups were found for second line treatment with rituximab (77% and 92% in the observation and maintenance group p<0.05) and years since diagnosis (p<0.01). Besides, the proportion of people with a partial response was higher in the observation group (60%) compared to the maintenance group (33%). The maintenance group showed higher 3-year overall survival (75% versus 63%) and longer time till next treatment (p<0.01). Compared to the trial, our real-world population was older and fewer patients were diagnosed with stage IV FL. Real-world prescription of rituximab was comparable to the trial although cycles were prescribed more frequent. Daily practice data combined with trial efficacy data resulted in cost-effectiveness ratios between € 3,614 and € 5,246 per life year gained and €3,555 and € 5,156 per quality-adjusted life year. CONCLUSIONS: Real-world FL patients were not identical to trial patients emphasising the importance of studying real-world data. Nevertheless, these data also suggest that rituximab is an effective treatment in daily life. However, analysing non-randomised groups is challenging. Careful interpretation is required since observed dissimilarities between the groups suggested the representation of different types of patients. Nevertheless, real-world cost-effectiveness for second line rituximab maintenance was favourable compared to other haematological treatments. Disclosures: Pompen: Roche Netherlands: Employment. Révil:Roche Netherlands: Employment.

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