scholarly journals Adding Rituximab to Chemotherapy for Diffuse Large B-Cell Lymphoma Patients in Indonesia: A Cost Utility and Budget Impact Analysis

2022 ◽  
Author(s):  
Septiara Putri ◽  
Ery Setiawan ◽  
Siti Rizny F. Saldi ◽  
Levina Chandra ◽  
Euis Ratna Sari ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Cost Effective ◽  
Cost Utility ◽  
Budget Impact Analysis ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background This study aims to estimate the cost-effectiveness and budget impact of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) compared to CHOP for the treatment of patients with diffuse large B-cell lymphoma (DLBCL) in Indonesia. Methods We conducted a cost utility analysis using Markov model over a lifetime horizon, from a societal perspective. Clinical evidence was derived from published clinical trials. Direct medical costs were gathered from hospital data. Direct non-medical costs, indirect costs, and utility data were primarily gathered by interviewing the patients. We applied 3% discount rate for both costs and effect. All monetary data are converted into USD (1 USD = IDR 14,000, 2019). Probabilistic sensitivity analysis was performed. In addition, from a payer perspective, budget impact analysis was estimated using price reduction scenarios. Results The incremental cost-effectiveness ratio (ICER) of R-CHOP was USD 4,674/LYG and 9,280/QALY. If we refer to the threshold three times the GDP per capita (USD 11,538), R-CHOP could thus be determined as a cost-effective therapy. Its significant health benefit has contributed to the considerable ICER result. Although the R-CHOP has been considered a cost-effective intervention, the financial consequence of R-CHOP if remain in benefit package under National Health Insurance (NHI) system in Indonesia is considerably substantial, approximately USD 66 million with 75% price reduction scenario. Conclusions As a favorable treatment for DLBCL, R-CHOP ensures value for money in Indonesia. Budget impact analysis provides results which can be used as further consideration for decision-makers in matters related to benefit packages.

scholarly journals Microcosting and Budget Impact Analysis of Diffuse Large B-Cell Lymphoma Treatment in Malawi

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3558-3558
Author(s):  
Matthew Painschab ◽  
Racquel E Kohler ◽  
Satish Gopal
Keyword(s):  
Palliative Care ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Single Institution ◽  
First Line ◽  
Large B Cell Lymphoma ◽  
Line Chemotherapy ◽  
Large B Cell

Abstract INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) is the commonest NHL subtype in sub-Saharan Africa (SSA), as in other parts of the world. Limited prospective data from the region have shown that DLBCL is curable in a substantial proportion of cases with chemotherapy and appropriate supportive care. However, little is known about costs of DLBCL treatment in the region. METHODS: We conducted a microcosting and budget impact analysis from a health systems prospective in Malawi, a low-income country in SSA. All costs were determined based on real-world costs for treating DBLCL patients at Kamuzu Central Hospital (KCH), a national teaching hospital in Lilongwe, Malawi, as part of a prospective, ongoing, longitudinal cohort study, the KCH Lymphoma Study. We calculated costs of care for palliative care only, first-line chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP), and second-line chemotherapy for relapsed/refractory DLBCL with either ifosfamide, cisplatin, prednisone, and etoposide (EPIC) or gemcitabine and oxaliplatin (GemOx). Cost data were taken directly from costs paid for goods and services at KCH. Costs were calculated on a per-patient, activity basis, and total costs were estimated based on the average patient experience in our cohort through two years of care. Likewise, data from the KCH Lymphoma Study was used to estimate supportive care events and costs, including the number of hospitalizations during treatment for each type of chemotherapy delivered. Personnel costs were calculated based on interviews of clinic personnel, as well as actively observing time spent on clinical activities. Overhead costs consisted primarily of pathology and laboratory infrastructure and were amortized over 25 years. All costs were collected in, or converted to, 2017 USD using Malawian GDP deflator. Total cost is also shown in International Dollars to facilitate comparisons across countries. Finally, using national cancer registry data and data from the KCH Lymphoma Study, we calculated the annual budget impact for Malawi to treat all DLBCL cases. RESULTS: All costs are shown on a per-patient basis (Table 1) using median chemotherapy cycles as received by the historical cohort of patients in the KCH Lymphoma Study, with follow-up visits for two years from chemotherapy initiation. Median number of chemotherapy cycles were as follows: CHOP (5), EPIC (3.5), and GemOx (5). CONCLUSIONS: To our knowledge, this is one of the first studies to rigorously examine cost and budget implications of DLBCL care in SSA. We calculated that first-line chemotherapy with CHOP can be delivered for $1050 more per patient compared with palliative care alone in this single-institution microcosting analysis. Strengths include microcosting based on real-life costs derived from utilization data in this highly resource-limited setting. Although this single-institution study may limit generalizability, these data can help guide resource allocation for a common curable cancer throughout SSA. Planned analyses include an ongoing formal cost-effectiveness analysis to compare DLBCL treatment to other accepted health care interventions in SSA. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cost Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Multiply Relapsed or Refractory Adult Large B-Cell Lymphoma

2019 ◽  
Vol 37 (24) ◽  
pp. 2105-2119 ◽  
Author(s):  
John K. Lin ◽  
Lori S. Muffly ◽  
Michael A. Spinner ◽  
James I. Barnes ◽  
Douglas K. Owens ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Life Expectancy ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Uncertainty Interval ◽  
Large B Cell Lymphoma ◽  
Car T ◽  
Large B Cell

PURPOSE Two anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapies are approved for diffuse large B-cell lymphoma, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel; each costs $373,000. We evaluated their cost effectiveness. METHODS We used a decision analytic Markov model informed by recent multicenter, single-arm trials to evaluate axi-cel and tisagenlecleucel in multiply relapsed/refractory, adult, diffuse large B-cell lymphoma from a US health payer perspective over a lifetime horizon. Under a range of plausible long-term effectiveness assumptions, each therapy was compared with salvage chemoimmunotherapy regimens and stem-cell transplantation. Main outcomes were undiscounted life years, discounted lifetime costs, discounted quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (3% annual discount rate). Sensitivity analyses explored uncertainty. RESULTS In an optimistic scenario, assuming a 40% 5-year progression-free survival (PFS), axi-cel increased life expectancy by 8.2 years at $129,000/QALY gained (95% uncertainty interval, $90,000 to $219,000). At a 30% 5-year PFS, improvements in life expectancy were more modest (6.4 years) and expensive ($159,000/QALY gained [95% uncertainty interval, $105,000 to $284,000]). In an optimistic scenario, assuming a 35% 5-year PFS, tisagenlecleucel increased life expectancy by 4.6 years at $168,000/QALY gained (95% uncertainty interval, $105,000 to $414,000/QALY). At a 25% 5-year PFS, improvements in life expectancy were smaller (3.4 years) and more expensive ($223,000/QALY gained [95% uncertainty interval, $123,000 to $1,170,000/QALY]). Administering CAR-T to all indicated patients would increase US health care costs by approximately $10 billion over 5 years. Price reductions to $250,000 and $200,000, respectively, or payment only for initial complete response (at current prices) would allow axi-cel and tisagenlecleucel to cost less than $150,000/QALY, even at 25% PFS. CONCLUSION At 2018 prices, it is possible that both CAR-T therapies meet a less than $150,000/QALY threshold. This depends on long-term outcomes compared with chemoimmunotherapy and stem-cell transplantation, which are uncertain. Widespread adoption would substantially increase non-Hodgkin lymphoma health care costs. Price reductions or payment for initial response would improve cost effectiveness, even with modest long-term outcomes.

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