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Lueza B, Aupérin A, Rigaud C, Gross TG, Pillon M, Delgado RF, Uyttebroeck A, Amos Burke GA, Zsíros J, Csóka M, Simonin M, Patte C, Minard-Colin V, Bonastre J. Cost-effectiveness analysis alongside the inter-B-NHL ritux 2010 trial: rituximab in children and adolescents with B cell non-Hodgkin's lymphoma. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:307-317. [PMID: 37058173 PMCID: PMC10858928 DOI: 10.1007/s10198-023-01581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES The randomized controlled trial Inter-B-NHL ritux 2010 showed overall survival (OS) benefit and event-free survival (EFS) benefit with the addition of rituximab to standard Lymphomes Malins B (LMB) chemotherapy in children and adolescents with high-risk, mature B cell non-Hodgkin's lymphoma. Our aim was to assess the cost-effectiveness of rituximab-chemotherapy versus chemotherapy alone in the French setting. METHODS We used a decision-analytic semi-Markov model with four health states and 1-month cycles. Resource use was prospectively collected in the Inter-B-NHL ritux 2010 trial (NCT01516580). Transition probabilities were assessed from patient-level data from the trial (n = 328). In the base case analysis, direct medical costs from the French National Insurance Scheme and life-years (LYs) were computed in both arms over a 3-year time horizon. Incremental net monetary benefit and cost-effectiveness acceptability curve were computed through a probabilistic sensitivity analysis. Deterministic sensitivity analysis and several sensitivity analyses on key assumptions were also conducted, including one exploratory analysis with quality-adjusted life years as the health outcome. RESULTS OS and EFS benefits shown in the Inter-B-NHL ritux 2010 trial translated into the model by rituximab-chemotherapy being the most effective and also the least expensive strategy over the chemotherapy strategy. The mean difference in LYs between arms was 0.13 [95% CI 0.02; 0.25], and the mean cost difference € - 3 710 [95% CI € - 17,877; € 10,525] in favor of rituximab-chemotherapy group. For a € 50,000 per LY willingness-to-pay threshold, the probability of the rituximab-chemotherapy strategy being cost-effective was 91.1%. All sensitivity analyses confirmed these findings. CONCLUSION Adding rituximab to LMB chemotherapy in children and adolescents with high-risk mature B-cell non-Hodgkin's lymphoma is highly cost-effective in France. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01516580.
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Affiliation(s)
- Béranger Lueza
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France
- Oncostat CESP - Labeled Ligue Contre le Cancer, INSERM 1018, Université Paris-Saclay, UVSQ, Villejuif, France
| | - Anne Aupérin
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France
- Oncostat CESP - Labeled Ligue Contre le Cancer, INSERM 1018, Université Paris-Saclay, UVSQ, Villejuif, France
| | - Charlotte Rigaud
- Département de Cancérologie de l'Enfant et l'adolescent, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Thomas G Gross
- Department of Pediatrics, Center for Cancer and Blood Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | - Marta Pillon
- Pediatric Hematology and Oncology, University of Padova, Padua, Italy
| | - Rafael F Delgado
- Pediatric Hematology and Oncology, University of Valencia, Valencia, Spain
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Louvain, Belgium
| | - G A Amos Burke
- Department of Paediatric Haematology, Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - József Zsíros
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Monika Csóka
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Mathieu Simonin
- Department of Pediatric Oncology and Hematology, Armand Trousseau Hospital-APHP, Sorbonne University, Paris, France
| | - Catherine Patte
- Département de Cancérologie de l'Enfant et l'adolescent, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Véronique Minard-Colin
- Département de Cancérologie de l'Enfant et l'adolescent, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
- INSERM 1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julia Bonastre
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
- Oncostat CESP - Labeled Ligue Contre le Cancer, INSERM 1018, Université Paris-Saclay, UVSQ, Villejuif, France.
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Monga N, Garside J, Gurung B, Quigley J, O'Donovan P, Tapprich C, Nastoupil L, Thieblemont C, Loefgren C. Cost-Effectiveness Analyses, Costs and Resource Use, and Health-Related Quality of Life in Patients with Follicular or Marginal Zone Lymphoma: Systematic Reviews. PHARMACOECONOMICS - OPEN 2020; 4:575-591. [PMID: 32200522 PMCID: PMC7688753 DOI: 10.1007/s41669-020-00204-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Follicular lymphoma (FL) and marginal zone lymphoma (MZL) are types of indolent non-Hodgkin lymphoma (NHL) that develop in the B lymphocytes (also known as B cells). OBJECTIVE The aim of this study was to conduct a comprehensive review of studies relating to cost effectiveness, costs and resource use, and health-related quality of life (HRQoL) in patients with FL or MZL. METHODS Three separate systematic reviews were conducted to identify all published evidence on cost effectiveness, costs and resource use, and HRQoL between 2007 and March 2017 using the MEDLINE®, MEDLINE in-process, E-pubs ahead of print (Ovid SP®), Embase (Ovid SP®), NHS EED, and EconLit databases. Select congress proceedings were also searched. Two systematic reviewers independently reviewed titles, abstracts, and full papers against eligibility criteria. Relevant data were extracted into bespoke data extraction templates (DETs) by a single systematic reviewer; these data were then validated for accuracy by a second reviewer against clean copies of the relevant publications. RESULTS A total of 25 cost-effectiveness studies (24 in FL; 1 in FL and MZL) met the eligibility criteria. Markov models were the most utilised cost-effectiveness model. US FL studies reported an incremental cost-effectiveness ratio (ICER) of $28,565/QALY for first-line rituximab-cyclophosphamide, vincristine, and prednisone (R-CVP) versus CVP, and $43,000/QALY for second-line obinutuzumab plus bendamustine (G + B) followed by G maintenance versus B. In the UK, ICERs were £1529-10,834/quality-adjusted life-year (QALY) for first-line rituximab + chemotherapy versus chemotherapy, £27,988/QALY for second-line G + B + G-maintenance versus B, and £62,653/QALY for second-line idelalisib versus chemotherapy and/or rituximab. Five costs/resource use and four HRQoL studies were identified in FL, and none in MZL. US mean lifetime costs in first-line patients ranged from $108,000 (rituximab) to $130,300 (rituximab-cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone [CHOP]), and from £2185 (watch-and-wait) to £17,054 (chemotherapy) in the UK. In a multinational study, more rituximab-refractory patients receiving G + B + G-maintenance reported a meaningful improvement in total FACT-Lym scores compared with patients receiving B. In the UK, total FACT-Lym scores were meaningfully higher for newly diagnosed patients compared with patients with progression (136.04 vs. 109.7). CONCLUSIONS AND RELEVANCE We found a small body of evidence of quality of life, and potentially cost-effective treatment options for FL; however, no evidence was reported on MZL specifically. The significant data gaps in knowledge in these diseases demonstrate a marked need for further studies.
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Affiliation(s)
- Neerav Monga
- Global Market Access and Health Policy, Janssen Global Oncology, 19 Green Belt Dr., Toronto, ON, M3C 1L9, Canada.
| | | | | | | | | | | | - Loretta Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Auweiler PWP, Müller D, Stock S, Gerber A. Cost effectiveness of rituximab for non-Hodgkin's lymphoma: a systematic review. PHARMACOECONOMICS 2012; 30:537-549. [PMID: 22612993 DOI: 10.2165/11591160-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The monoclonal antibody rituximab has shown clinical effectiveness in combination with chemotherapy for the treatment of non-Hodgkin's lymphoma (NHL) in several randomized controlled studies. Rituximab maintenance therapy is associated with significant improvement in progression-free and overall survival in patients with NHL. However, treatment with rituximab causes considerable costs for healthcare systems. OBJECTIVE This article provides an overview of economic evaluations of rituximab and appraises their methodological quality. METHODS A systematic literature search of cost-effectiveness studies on rituximab was carried out in nine electronic databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews (CDSR), the German Agency of Health Technology Assessment (DAHTA) database, German Institute for Quality Improvement (DIQ)-Literatur, DIQ-Projekte, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessments (HTA) database and Sozialmedizin (SOMED) [languages: English, German, Dutch, French, Spanish and Italian; publication period: 1998 to 2010]. Based on pre-specified inclusion criteria, cost-effectiveness studies were identified that compared standard chemotherapy with standard chemotherapy plus rituximab in patients with a subtype of NHL. The methodological quality of the studies was assessed using a quality checklist. RESULTS Fourteen economic evaluations from seven different countries were included in the review. All economic evaluations reported incremental cost-effectiveness ratios (ICERs) for the add-on therapy with rituximab that were below the country-specific thresholds. The studies differed significantly in their characteristics and methodological rigour. Most studies lacked transparency regarding identification and justification of data. In several studies, the rationale for the model structure was not described appropriately. CONCLUSION Adding rituximab to standard chemotherapy is considered a cost-effective treatment option for NHL. However, the results of the analyses should be interpreted with caution due to methodological limitations.
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Affiliation(s)
- Philipp W P Auweiler
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne-AR, Cologne, Germany.
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Kasteng F, Erlanson M, Hagberg H, Kimby E, Relander T, Lundkvist J. Cost-effectiveness of maintenance rituximab treatment after second line therapy in patients with follicular lymphoma in Sweden. Acta Oncol 2009; 47:1029-36. [PMID: 18607857 DOI: 10.1080/02841860802120028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Rituximab has significantly improved the prognosis for patients with both indolent and aggressive non-Hodgkin's lymphoma. An economic evaluation was carried out to assess the cost-effectiveness in Sweden of rituximab as maintenance therapy for patients with follicular lymphoma in remission after second line therapy. MATERIALS AND METHODS The incremental cost and effectiveness of rituximab maintenance therapy versus observation were evaluated in a health-state transition model. Primary effect measures were quality-adjusted life-years (QALY) and life-years gained (LYG). Model state transitions were calculated based on progression-free and overall survival data from the EORTC20981 trial. The analysis was made from the perspective of the healthcare provider, including direct medical costs presented in euro, 2007 value. Effects and costs were discounted at a 3% annual rate. The stability of the base case results were tested in one-way and probabilistic sensitivity analyses. RESULTS The evaluation assessed rituximab maintenance therapy to be associated with an incremental cost per QALY gained of euro 12,600 and an incremental cost per LYG of euro 11,200. The average discounted life expectancy for patients on rituximab maintenance was 1.0 year longer than for patients on observation (5.96 vs. 4.94 years). Rituximab maintenance was associated with an additional 0.9 QALY, and total costs per patient were euro 11,500 higher in the treatment arm, compared to observation. DISCUSSION The results indicate that rituximab maintenance treatment after successful induction therapy for patients with relapsed/refractory follicular lymphoma in Sweden is cost-effective compared to observation.
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