The Cost-Effectiveness of Rituximab, Cyclophosphamide, Vincristine and Prednisolone (RCVP) Compared with CVP for the Treatment of Follicular Non-Hodgkin’s Lymphoma (NHL) in the UK.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 345-345 ◽  
Author(s):  
Gavin Lewis ◽  
Robert E. Marcus ◽  
Stephen J. Proctor ◽  
Marlene Gyldmark ◽  
James Creeden ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Service ◽  
Life Expectancy ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
The Uk ◽  
First Line Treatment ◽  
Health Service Costs

Abstract Background: A large phase III randomised control trial (Marcus et al, Blood2005, 105;4) has demonstrated that rituximab plus CVP compared with CVP alone improved time to treatment failure (p<0.0001) and a trend towards overall survival benefit (p=0.06). No analysis has yet been published relating to long-term clinical outcomes and costs of adding rituximab as a first-line treatment. Cost-effectiveness (CE) analysis aims to evaluate the additional costs and patient benefits (expressed as quality adjusted life years – QALYs) of an intervention (RCVP) compared with an alternative intervention (CVP). Some healthcare systems have CE thresholds to judge if the incremental cost-effectiveness ratio (ICER) is within acceptable limits; these thresholds vary across countries. Aims: To estimate the long-term clinical outcomes, direct health-service costs and incremental CE of RCVP compared with CVP for the first-line treatment of patients with follicular NHL. Methods: A CE analysis was developed using a state-transition Markov model, which simulated the lifetime progression of follicular NHL patients. Baseline patient characteristics were assumed equal to those in the Marcus et al study, with a mean age of 53. The CE of RCVP was evaluated using an ICER, based upon the UK health-service perspective. The model starts from the time of receiving first treatment until death. Patients could be in one of 3 discrete health states: progression-free survival, progression or death. The risk of disease progression for RCVP and CVP patients was derived directly from the results of the Marcus et al study, based upon a median trial follow-up of 42 months. The risk of death following disease progression was based upon outcomes reported by a UK registry of second-line follicular NHL patients (n=249). Patient quality of life was incorporated within the analysis using utility scores for each health state from a survey of follicular NHL patients (n=165) who completed the EQ-5D questionnaire. Cost and QALYs were discounted at 3.5%. Costs for patient monitoring and drug costs for second-line and later treatments were taken from published literature. Second-line and later treatments were assumed equivalent in both arms of the model. Results: Over the lifetime of a patient rituximab as a first-line treatment strategy generated higher total costs, but greater QALYs, compared with CVP alone. The average lifetime health-service costs per patient were £20,347 ($37,650) and £9,977 ($18,462) per patient for RCVP and CVP, respectively. Life expectancy was estimated as 9.4 yrs for RCVP and 7.2 yrs for CVP (undiscounted). Average QALYs for RCVP and CVP were 5.7 and 4.5 per patient, respectively (undiscounted). The ICER (discounted) of RCVP compared with CVP was £8,290 ($15,340) per QALY. Although there is uncertainty associated with the progression of follicular lymphoma and treatment costs, the ICER did not exceed £21,500 ($39,784) despite a wide variation in each parameter used in the analysis. Conclusions: Rituximab in combination with CVP is a cost-effective treatment option for the first-line treatment of follicular NHL. The clinical advantages of RCVP compared with CVP alone are predicted to generate an increase in life expectancy and QALYs. The resulting ICER for RCVP is well within the UK threshold of CE.

A UK Cost-Effectiveness Analysis Comparing First Line Treatment with Rituximab in Combination with Fludarabine and Cyclophosphamide Versus Fludarabine and Cyclophosphamide Alone in Chronic Lymphocytic Leukemia (CLL) Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2392-2392 ◽  
Author(s):  
Konstantinos Papadakis ◽  
David Oscier ◽  
Emma SC Carr ◽  
Gavin Lewis ◽  
Rick Aultman
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Life Expectancy ◽  
Health State ◽  
Line Treatment ◽  
First Line ◽  
The Uk ◽  
Quality Adjusted Life ◽  
First Line Treatment

Abstract Introduction: This analysis assesses whether Rituximab added to a Fludarabine Cyclophosphamide regimen (R-FC) is a cost-effective first-line treatment option for previously untreated CLL patients, using evidence from the phase III randomised controlled trial, ML17102 (CLL8) (Hallek et al., ASH 2008). In this trial, R-FC significantly prolonged the primary endpoint of progression–free survival (PFS) compared to FC alone and was well tolerated with no unexpected safety signals. Methods: A cost-effectiveness model was developed to evaluate the life-time health outcomes and direct costs of R-FC compared to FC as first-line treatment for CLL patients in the UK. Patients were modelled to be in one of three health states; PFS, Progressed or Death. The best parametric fit (Weibull) was used to extrapolate PFS beyond the end of the CLL8 trial follow-up period to a 15 year life-time horizon. The number of patients in each treatment arm that died while in PFS was based on the maximum of either the observed rate of death or background mortality. Because median overall survival had not been reached in CLL-8, a Markov process was used to model the transition from the progressed health state to death. Given the non significant difference in post progression survival by treatment (R-FC or FC), patients transitioning from progression to death were modelled as a single population with mean time to death (Kaplan-Meier) converted to a monthly probability of dying. This approach is conservative in that treatment benefit is exclusively a function of time spent in PFS. This Markovian approach is conservative in that treatment benefit is exclusively a function of time spent in PFS. Predicted time in each health state was weighted using CLL utility scores (Hancock et. al. 2002) to account for patient quality of life and estimate the Quality Adjusted Life Years (QALYs). Drug administration, patient monitoring and pharmacy costs were taken from the NHS schedule of reference costs 2006 and the published literature. Blood transfusions, bone marrow transplants, stem cell therapy and second line CLL treatments collected prospectively in CLL8 were included in monitoring costs. The cost of treatment related grade 3 or 4 infections were not included in the analysis as the incidence between the two treatment arms was comparable (Hallek et al., ASH 2008). Both costs and outcomes were discounted by 3.5%. RESULTS: R-FC improves mean life expectancy by 1.33 years compared to FC alone. After adjusting for quality of life, the incremental quality-adjusted life expectancy estimated was 1.06 years. Improvements in health outcomes were attributed to an increase in the time R-FC patients spent in the PFS health state (1.17 years).Total direct costs were higher for R-FC by £13,081 per patient, however, this was partially offset by a reduction in medication and monitoring costs incurred in the progressed health state. The incremental cost-effectiveness ratios (ICERs) were estimated to be £9558 per Life Year Gained with R-FC. When health-related quality of life was taken into account, the ICER was £12,387 per QALY gained for R-FC, well below commonly accepted thresholds in the UK. Although there is uncertainty associated with the progression of CLL and relapse treatment costs, the ICER did not exceed £22,458 per QALY despite a wide variation in each parameter value used in the probabilistic sensitivity analysis. CONCLUSIONS: Based on the significant prolongation of PFS demonstrated in CLL8, first-line R-FC substantially increases quality-adjusted life expectancy for CLL patients and is well within the UK threshold of cost-effectiveness. The sensitivity analysis provides adequate reassurance that the cost-effectiveness of R-FC held under most plausible scenarios.

scholarly journals Potentially Cured Follicular Lymphoma (PC-FL). an Analysis of 56 Cases with Prognostic Factors Evaluation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5328-5328
Author(s):  
Samantha Ferrari ◽  
Alessandra Tucci ◽  
Gloria Valimberti ◽  
Antonella Anastasia ◽  
Chiara Bottelli ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Board Of Directors ◽  
Median Duration ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Advisory Committees ◽  
Younger Age ◽  
First Line Treatment

Abstract Introduction: Advanced stage follicular lymphoma (FL) is generally considered incurable. Although multiple remissions after treatment are possible, relapse is considered the rule, and the time to progression tends to become shorter after each relapse (Johnson, JCO 1995). Over the last decades, after the introduction of monoclonal anti-CD20 antibodies and of better treatment programs, the prognosis of FL has markedly improved from a median OS of 7 years to a 10-year OS rate >80%. Moreover, clinical observations of patients (pts) experiencing very long progression-free periods despite more than one previous treatment failure, have become not rare, suggesting that some pts could achieve operational FL cure. To assess the frequency of those prolonged long-term remissions and search for potential predictive factors, we have retrospectively analyzed the consecutive series of pts with FL seen at our institution. Methods: FL pts, aged >18 years, in maintained remission for more than 5 years after at least two lines of treatment were selected as "potentially cured" FL (PC-FL) and analyzed in detail. Their main characteristics at diagnosis and at last relapse, the different lines of treatment received and the time intervals (time to next treatment: TTNT) between them, were recorded and compared with those of FL pts seen in the same period (control group). Treatment strategies used were grouped and defined as follows: radiotherapy or surgery, for stage I-II (local), anthracycline and/or alkylating agents regimens (Alk/Ant), purine analogues regimens (Pur), monoclonal antibodies/radioimmunoconjugates as single agent (MoAb), autologous transplantation (ASCT). Results and discussion: Among 385 consecutive FL pts seen from January 1987 to December 2011, 56 (14,5%) met criteria for PC-FL. Their clinicopathological features at diagnosis, compared to controls, are shown in Table I. There were no significant differences except for a younger age (51 vs 58 years, p<0.00016) and for a lower frequency of grade 3a histology (p=0.04) in PC-FL pts. First line treatment used did also not differ (p=0.29). Among PC-FL pts, 33 received two, 16 received 3 and 7 more than 3 treatment lines. The median duration of last complete remission was 118+ months, whereas the median duration of the remission preceding the last treatment had been 24 months; disease duration from diagnosis to the last relapse preceding long term remission had been 50,5 months. The last treatments received before long-term remission were variable including local in 10 (18%), Alk/Ant in 5 (9%), Pur in 11 (19%), MoAb in 10 (18%) and ASCT in 20 (36%). Pts characteristics at last relapse and remission duration were similar among different treatment subgroups, except that more pts in localized stage received local treatments. Comparing clinicopathological characteristics of PC-FL pts at diagnosis and at last relapse there were no differences except for FLIPI score, which was significantly lower at relapse (low FLIPI 34% at diagnosis, 68% at relapse, p=0.002). First-line and last treatments were similar except that more pts underwent ASCT as last treatment, as expected since frontline ASCT is not recommended. In 10 pts TTNT after first-line was longer than 5 years and 7 of them are still in prolonged remission (median 11+ years) after second-line treatment, representing a particularly favorable subgroup. In 26 (46%) of PC-FL pts TTNT was shorter than 24 months after first line therapy. Among 14 of them who received R-chemo at diagnosis (POD24, Casulo, JCO 2015), 8 (57%) obtained long remission after ASCT, given in second line in six. Conversely, ASCT was used in only 1 of 12 pts not receiving Rituximab at diagnosis. Conclusions: Approximately 15% of FL pts could currently achieve a very prolonged remission of about 10 years, even after multiple relapses. Its duration was 5x that of the last treatment line and more than twice that of active lymphoma, strongly suggesting the possibility of having achieved lymphoma cure. Younger age and grade 1-2 FL histology at diagnosis, and FLIPI low risk at relapse favored the achievement of PC-FL status. No specific treatment was associated with PC-FL and even an early relapse after first line treatment did not preclude to reach PC-FL, although early ASCT may be more effective for POD24 patients. Whether the achievement of PC-FL status may be related to biological factors will be interesting to be investigated in the next future. Disclosures Rossi: Roche: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees; Teva: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Jazz: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria; Mundipharma: Honoraria; BMS: Honoraria; Sandoz: Honoraria.

Cost-effectiveness Analysis of Caspofungin and Fluconazole for Primary Treatment of Invasive Candidiasis and Candidemia in Ethiopia

2022 ◽  
Author(s):  
Gebremedhin Beedemariam Gebretekle ◽  
Atalay Mulu Fentie ◽  
Girma Tekle Gebremariam ◽  
Eskinder Eshetu Ali ◽  
Daniel Asfaw Erku ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Invasive Candidiasis ◽  
Cost Effective ◽  
Primary Treatment ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
System Perspective ◽  
The Cost ◽  
First Line Treatment

Abstract Background: Caspofungin was shown to be more effective than fluconazole in treating patients with invasive candidiasis and/or candidaemia (IC/C). However, cost-effectiveness of caspofungin for treating IC/C in Ethiopia remains unknown. We aimed to assess the cost-effectiveness of caspofungin compared to fluconazole as primary treatment of IC/C in Ethiopia.Methods: A Markov cohort model was developed to compare the cost-utility of caspofungin versus fluconazole antifungal agents as first-line treatment for adult inpatients with IC/C from the Ethiopian health system perspective. Treatment outcome was categorized as either a clinical success or failure, with clinical failure being switched to a different antifungal medication. Liposomal amphotericin B (L-AmB) was used as a rescue agent for patients who had failed caspofungin treatment, while caspofungin or L-AmB were used for patients who had failed fluconazole treatment. Primary outcomes were expected quality-adjusted life years (QALYs), costs (US$2021), and the incremental cost-effectiveness ratio (ICER). QALYs and costs were discounted at 3% annually. Cost data was obtained from Addis Ababa hospitals while locally unavailable data were derived from the literature. Cost-effectiveness was assessed against the recommended threshold of 50% of Ethiopia’s gross domestic product/capita. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the findings.Results: In the base-case analysis, treatment of IC/C with caspofungin as first-line treatment resulted in better health outcomes (12.86 QALYs) but higher costs (US$7,714) compared to fluconazole-initiated treatment followed by caspofungin (12.30 QALYs; US$3,217) or L-AmB (10.92 QALYs; US$2,781) as second-line treatment. Caspofungin as primary treatment for IC/C was not cost-effective when compared to fluconazole-initiated therapies. Fluconazole-initiated treatment followed by caspofungin was cost-effective for the treatment of IC/C compared to fluconazole with L-AmB as second-line treatment, at US$316/QALY gained. Our findings were sensitive to medication costs, drug effectiveness, infection recurrence, and infection-related mortality rates. Probabilistic sensitivity analysis confirmed the stability of our findings.Conclusions: Our study showed that the use of caspofungin as primary treatment for IC/C in Ethiopia was not cost-effective when compared with fluconazole-initiated treatment alternatives. The findings supported the use of fluconazole-initiated therapy with caspofungin as a second-line treatment to treat IC/C in Ethiopia and other low-income countries.

Sign in / Sign up

Export Citation Format

Share Document