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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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Rho H, Jeong IJH, Prica A. Ibrutinib Plus RCHOP versus RCHOP Only in Young Patients with Activated B-Cell-like Diffuse Large B-Cell Lymphoma (ABC-DLBCL): A Cost-Effectiveness Analysis. Curr Oncol 2023; 30:10488-10500. [PMID: 38132398 PMCID: PMC10742773 DOI: 10.3390/curroncol30120764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
The standard treatment for Diffuse Large B-Cell Lymphoma (DLBCL) is rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP). However, many patients require subsequent treatment after relapsed disease. The ABC subtype of DLBCL (ABC-DLBCL) has a worse prognosis, and the PHOENIX trial explored adding ibrutinib to RCHOP for this patient population. The trial showed favorable outcomes for younger patients, and our study aimed to inform clinical decision-making via a cost-effectiveness model to compare RCHOP with and without ibrutinib (I-RCHOP). A Markov decision analysis model was designed to compare the treatments for patients younger than 60 years with ABC-DLBCL. The model considered treatment pathways, adverse events, relapses, and death, incorporating data on salvage treatments and novel therapies. The results indicated that I-RCHOP was more cost-effective, with greater quality-adjusted life years (QALY, 15.48 years vs. 14.25 years) and an incremental cost-effectiveness ratio (ICER) of CAD 34,111.45/QALY compared to RCHOP only. Sensitivity analyses confirmed the model's robustness. Considering the high market price for ibrutinib, I-RCHOP may be more costly. However, it is suggested as the preferred cost-effective strategy for younger patients due to its benefits in adverse events, overall survival, and quality of life. The decision analytic model provided relevant and robust results to inform clinical decision-making.
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Affiliation(s)
- Hayeong Rho
- Department of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada (A.P.)
| | - Irene Joo-Hyun Jeong
- Department of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada (A.P.)
| | - Anca Prica
- Department of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada (A.P.)
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 1V7, Canada
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Putri S, Setiawan E, Saldi SRF, Khoe LC, Sari ER, Megraini A, Nadjib M, Sastroasmoro S, Armansyah A. Adding rituximab to chemotherapy for diffuse large B-cell lymphoma patients in Indonesia: a cost utility and budget impact analysis. BMC Health Serv Res 2022; 22:553. [PMID: 35468783 PMCID: PMC9040215 DOI: 10.1186/s12913-022-07956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) has been used to treat patients with diffuse large B-cell lymphoma (DLBCL) under National Health Insurance (NHI) scheme in Indonesia. This study aims to estimate its cost-effectiveness and budget impact. 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 4674/LYG and 9280/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 35.00 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. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07956-w.
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Affiliation(s)
- Septiara Putri
- Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java, 16424, Indonesia. .,Center for Health Economics and Policy Studies (CHEPS) University of Indonesia, Depok, West Java, 16424, Indonesia.
| | - Ery Setiawan
- Center for Health Economics and Policy Studies (CHEPS) University of Indonesia, Depok, West Java, 16424, Indonesia
| | - Siti Rizny F Saldi
- Center for Clinical Epidemiology and Evidence Based Medicine (CEEBM) Cipto Mangunkusomo Hospital, Jakarta, 10430, Indonesia
| | - Levina Chandra Khoe
- Community Medicine Department, Faculty of Medicine University of Indonesia, Jakarta, 10430, Indonesia
| | - Euis Ratna Sari
- Center for Health Economics and Policy Studies (CHEPS) University of Indonesia, Depok, West Java, 16424, Indonesia
| | - Amila Megraini
- Center for Health Economics and Policy Studies (CHEPS) University of Indonesia, Depok, West Java, 16424, Indonesia
| | - Mardiati Nadjib
- Indonesian Health Technology Assessment Committee, Jakarta, 12950, Indonesia
| | | | - Armansyah Armansyah
- Center for Health Financing and Insurance, Ministry of Health Republic of Indonesia, Jakarta, 12950, Indonesia
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Cost-Effectiveness of Molecularly Guided Treatment in Diffuse Large B-Cell Lymphoma (DLBCL) in Patients under 60. Cancers (Basel) 2022; 14:cancers14040908. [PMID: 35205656 PMCID: PMC8870002 DOI: 10.3390/cancers14040908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Classifying diffuse large B-cell lymphoma (DLBCL) into cell-of-origin (COO) subtypes could allow for personalized cancer control. Evidence suggests that subtype-guided treatment may be beneficial in the activated B-cell (ABC) subtype of DLBCL, among patients under the age of 60. Methods: We estimated the cost-effectiveness of age- and subtype-specific treatment guided by gene expression profiling (GEP). A probabilistic Markov model examined costs and quality-adjusted life-years gained (QALY) accrued to patients under GEP-classified COO treatment over a 10-year time horizon. The model was calibrated to evaluate the adoption of ibrutinib as a first line treatment among patients under 60 years with ABC subtype DLBCL. The primary data source for efficacy was derived from published estimates of the PHOENIX trial. These inputs were supplemented with patient-level, real-world data from BC Cancer, which provides comprehensive cancer services to the population of British Columbia. Results: We found the cost-effectiveness of GEP-guided treatment vs. standard care was $77,806 per QALY (24.3% probability of cost-effectiveness at a willingness-to-pay (WTP) of $50,000/QALY; 53.7% probability at a WTP of $100,000/QALY) for first-line treatment. Cost-effectiveness was dependent on assumptions around decision-makers’ WTP and the cost of the assay. Conclusions: We encourage further clinical trials to reduce uncertainty around the implementation of GEP-classified COO personalized treatment in this patient population.
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Khatib MY, Allafi SM, Nashwan AJ. Serum sickness following rituximab therapy in a patient with pemphigus vulgaris: A case report. Clin Case Rep 2021; 9:751-754. [PMID: 33598239 PMCID: PMC7869366 DOI: 10.1002/ccr3.3642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 11/12/2022] Open
Abstract
Serum sickness, a reaction presenting with a classic triad (fever, rash, myalgia/arthralgia), is considered as a rare adverse event following monoclonal antibodies and specifically following treatment with rituximab. This report describes a case of serum sickness in a newly treated young male patient with rituximab for pemphigus vulgaris.
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Affiliation(s)
- Mohamad Y. Khatib
- Medical Intensive Care DepartmentHazm Mebaireek General Hospital (HMGH)Hamad Medical Corporation (HMC)DohaQatar
| | - Solaiman M. Allafi
- Medical Intensive Care DepartmentHazm Mebaireek General Hospital (HMGH)Hamad Medical Corporation (HMC)DohaQatar
| | - Abdulqadir J. Nashwan
- Education & Practice DevelopmentHazm Mebaireek General Hospital (HMGH)Hamad Medical Corporation (HMC)DohaQatar
- University of Calgary in Qatar (UCQ)DohaQatar
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Fracchiolla NS, Artuso S, Cortelezzi A, Pelizzari AM, Tozzi P, Bonfichi M, Bocchio F, Gargantini L, De Rosa E, Vighi GD, Prestini L, Sammassimo S, Frungillo N, Pasquini MC, Ragazzi A, Boghi D, Pastore A, Lanzi E, Gritti G, Quaresmini G, Voltolini S, Gaiardoni R, Corti C, Vilardo MC, La Targia ML, Berini G, Magagnoli M, Bacci C, Consonni D, Rivolta AL, Muti G. FarmaREL: An Italian pharmacovigilance project to monitor and evaluate adverse drug reactions in haematologic patients. Hematol Oncol 2017; 36:299-306. [DOI: 10.1002/hon.2451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Nicola S. Fracchiolla
- UOC Oncoematologia; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Silvia Artuso
- UOC Oncoematologia; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | - Agostino Cortelezzi
- UOC Oncoematologia; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | | | - Paola Tozzi
- UO Ematologia; Spedali Civili; Brescia Italy
| | | | - Federica Bocchio
- SC Ematologia; Fondazione IRCCS Policlinico S Matteo; Pavia Italy
| | - Livio Gargantini
- SC Ematologia; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Elisa De Rosa
- SC Ematologia; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Giuseppe D. Vighi
- SS Farmacovigilanza e Farmacologia clinica; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Lucia Prestini
- SS Farmacovigilanza e Farmacologia clinica; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Simona Sammassimo
- Divisione di Oncoematologia; Istituto Europeo di Oncologia; Milan Italy
| | - Niccolò Frungillo
- Divisione di Oncoematologia; Istituto Europeo di Oncologia; Milan Italy
| | | | | | - Daniele Boghi
- UO Oncologia; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Alessia Pastore
- UO Oncologia; Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | | | | | | | | | | | - Consuelo Corti
- UO di Ematologia e Trapianto di Midollo; IRCCS Ospedale San Raffaele; Milan Italy
| | | | | | - Giacomo Berini
- UO Oncologia Medica; AO Ospedale di Circolo; Busto Arsizio Italy
| | - Massimo Magagnoli
- Dipartimento di Ematologia ed Oncologia; Humanitas Cancer Center, Rozzano; Milan Italy
| | | | - Dario Consonni
- UO Epidemiologia; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico; Milan Italy
| | | | - Giuliana Muti
- Commissione Qualità e Risk Management REL; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
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The Rituximab Biosimilar CT-P10 in Rheumatology and Cancer: A Budget Impact Analysis in 28 European Countries. Adv Ther 2017; 34:1128-1144. [PMID: 28397080 PMCID: PMC5427122 DOI: 10.1007/s12325-017-0522-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Indexed: 12/20/2022]
Abstract
Introduction New biosimilars of monoclonal antibodies are anticipated to bring significant cost savings and increase access to treatment. The rituximab biosimilar CT-P10 has recently been approved in Europe in all indications held by reference rituximab (RTX), including rheumatoid arthritis, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia. We analyzed the budgetary impact of the introduction of CT-P10 into the European Union (EU) for use in patients with rheumatoid arthritis and cancer diagnoses, using a budget impact analysis model. Methods The model used a base case scenario in which the 1-year uptake of CT-P10 was estimated at 30%, and the cost of CT-P10 was assumed to be 70% of the cost of RTX. A second 1-year scenario was also modeled, in which the market share of CT-P10 was assumed to be 50% (scenario 2). Finally, 3-year time horizon outcomes were calculated, in which the market share of CT-P10 was assumed to be 30%, 40%, and 50% in the first, second, and third years, respectively. Results In the base case scenario, the introduction of CT-P10 was associated with projected savings of €90.04 million in the first year, which would allow 7531 additional patients to access rituximab treatment. This was equivalent to a 6.4% increase in the number of rituximab-treated patients. In scenario 2, budget savings were €150.10 million, with a total of 12,551 additional patients able to access rituximab, equivalent to a 10.7% increase. Over a 3-year time horizon, projected budget savings were approximately €570 million, equating to 47,695 additional patients able to access rituximab. Conclusions The model predicted that the introduction of CT-P10 in the EU will be associated with significant budget savings, the reallocation of which will enable many more patients to access rituximab treatment. This is likely to have a significant impact on health gains at patient and societal levels. Funding: CELLTRION Healthcare Co., Ltd. sponsored the development and analysis of the budget impact analysis model. Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0522-y) contains supplementary material, which is available to authorized users.
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Wang HI, Smith A, Aas E, Roman E, Crouch S, Burton C, Patmore R. Treatment cost and life expectancy of diffuse large B-cell lymphoma (DLBCL): a discrete event simulation model on a UK population-based observational cohort. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:255-267. [PMID: 26969332 PMCID: PMC5313581 DOI: 10.1007/s10198-016-0775-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/18/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is the commonest non-Hodgkin lymphoma. Previous studies examining the cost of treating DLBCL have generally focused on a specific first-line therapy alone; meaning that their findings can neither be extrapolated to the general patient population nor to other points along the treatment pathway. Based on empirical data from a representative population-based patient cohort, the objective of this study was to develop a simulation model that could predict costs and life expectancy of treating DLBCL. METHODS All patients newly diagnosed with DLBCL in the UK's population-based Haematological Malignancy Research Network ( www.hmrn.org ) in 2007 were followed until 2013 (n = 271). Mapped treatment pathways, alongside cost information derived from the National Tariff 2013/14, were incorporated into a patient-level simulation model in order to reflect the heterogeneities of patient characteristics and treatment options. The NHS and social services perspective was adopted, and all outcomes were discounted at 3.5 % per annum. RESULTS Overall, the expected total medical costs were £22,122 for those treated with curative intent, and £2930 for those managed palliatively. For curative chemotherapy, the predicted medical costs were £14,966, £23,449 and £7376 for first-, second- and third-line treatments, respectively. The estimated annual cost for treating DLBCL across the UK was around £88-92 million. CONCLUSIONS This is the first cost modelling study using empirical data to provide 'real world' evidence throughout the DLBCL treatment pathway. Future application of the model could include evaluation of new technologies/treatments to support healthcare decision makers, especially in the era of personalised medicine.
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Affiliation(s)
- Han-I Wang
- Epidemiology and Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK.
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Eve Roman
- Epidemiology and Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, UK
| | - Russell Patmore
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull, UK
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Machado RIL, Scheinberg MA, Queiroz MYCFD, Brito DCSED, Guimarães MFBDR, Giovelli RA, Freire EAM. Use of rituximab as a treatment for systemic lupus erythematosus: retrospective review. EINSTEIN-SAO PAULO 2014; 12:36-41. [PMID: 24728244 PMCID: PMC4898237 DOI: 10.1590/s1679-45082014ao2706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 09/28/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To report the experience in three Brazilian institutions with the use of rituximab in patients with different clinical forms of lupus erythematosus systemic in activity. METHODS The study consisted of a sample of 17 patients with LES, who were already being treated, but that at some stage of the disease showed refractory symptoms. The patients were subdivided into groups according to the clinical manifestation, and the responses for the use of rituximab were rated as complete, partial or no response. Data were collected through a spreadsheet, and used specific parameters for each group. The treatment was carried on by using therapeutic dose of 1g, and repeating the infusion within an interval of 15 days. RESULTS The clinical responses to rituximab of the group only hematological and of the group only osteoarticular were complete in all cases. In the renal group there was a clinical complete response, two partial and one absent. In the renal and hematological group complete response, there was one death and a missing response. The pulmonary group presented a complete response and two partial. CONCLUSION The present study demonstrated that rituximab can bring benefits to patients with lupus erythematosus systemic, with good tolerability and mild side effects; it presented, however, variable response according to the system affected.
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Sharkey RM, Burton J, Goldenberg DM. Radioimmunotherapy of non-Hodgkin’s lymphoma: a critical appraisal. Expert Rev Clin Immunol 2014; 1:47-62. [DOI: 10.1586/1744666x.1.1.47] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Tetteh E, Morris S. Systematic review of drug administration costs and implications for biopharmaceutical manufacturing. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:445-456. [PMID: 23846573 DOI: 10.1007/s40258-013-0045-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The acquisition costs of biologic drugs are often considered to be relatively high compared with those of nonbiologics. However, the total costs of delivering these drugs also depend on the cost of administration. Ignoring drug administration costs may distort resource allocation decisions because these affect cost effectiveness. OBJECTIVES The objectives of this systematic review were to develop a framework of drug administration costs that considers both the costs of physical administration and the associated proximal costs; and, as a case example, to use this framework to evaluate administration costs for biologics within the UK National Health Service (NHS). METHODS We reviewed literature that reported estimates of administration costs for biologics within the UK NHS to identify how these costs were quantified and to examine how differences in dosage forms and regimens influenced administration costs. The literature reviewed were identified by searching the Centre for Review and Dissemination Databases (DARE, NHS EED and HTA); EMBASE (The Excerpta Medica Database); MEDLINE (using the OVID interface); Econlit (EBSCO); Tufts Medical Center Cost Effectiveness Analysis (CEA) Registry; and Google Scholar. RESULTS We identified 4,344 potentially relevant studies, of which 43 studies were selected for this systematic review. We extracted estimates of the administration costs of biologics from these studies. We found evidence of variation in the way that administration costs were measured, and that this affected the magnitude of costs reported, which could then influence cost effectiveness. CONCLUSIONS Our findings suggested that manufacturers of biologic medicines should pay attention to formulation issues and their impact on administration costs, because these affect the total costs of healthcare delivery and cost effectiveness.
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Affiliation(s)
- Ebenezer Tetteh
- Department of Applied Health Research, EPSRC Centre for Innovative Manufacturing in Emergent Macromolecular Therapies, University College of London, 1-19 Torrington Place, London, WC1E 7HB, UK,
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Follow-up of patients receiving rituximab for diffuse large B cell lymphoma: an overview of systematic reviews. Ann Hematol 2013; 92:1451-9. [DOI: 10.1007/s00277-013-1811-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 05/29/2013] [Indexed: 12/31/2022]
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Costo-efficacia di rituximab nella terapia di mantenimento in soggetti affetti da linfoma non-Hodgkin follicolare refrattario o recidivante. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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15
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Affiliation(s)
- David G Maloney
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA 98104-1029, USA.
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16
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Johnston KM, Marra CA, Connors JM, Najafzadeh M, Sehn L, Peacock SJ. Cost-effectiveness of the addition of rituximab to CHOP chemotherapy in first-line treatment for diffuse large B-cell lymphoma in a population-based observational cohort in British Columbia, Canada. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:703-11. [PMID: 20561333 DOI: 10.1111/j.1524-4733.2010.00737.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) has primarily been treated with cyclophosphamide, doxorubicin, vincristine, and predisone (CHOP) chemotherapy since the 1970s. Recently, the addition of rituximab to CHOP (CHOP-R) has been found to improve survival and trial-based results have suggested that it is a cost-effective alternative to CHOP. OBJECTIVES The objective in this study was to evaluate the cost-effectiveness of CHOP-R relative to CHOP in first-line treatment of DLBCL in a population-based setting in British Columbia, Canada. METHODS We created a patient-level simulation model describing potential pathways for DLBCL patients initiating treatment with either CHOP or CHOP-R. Model parameters were populated with statistical analyses of individual-level treatment and effectiveness data and published cost estimates. All results were stratified by age at treatment initiation (<60 years vs. ≥60 years). The base-case scenario was based on a 15-year time horizon and a 3% discount rate. Probabilistic sensitivity analysis was performed. All costs are reported as 2006 $CDN. RESULTS For the base-case scenario, incremental cost-effectiveness ratios (ICERs) for younger individuals ranged from $11,965 per disease-free life-year gained to $19,144 per quality-adjusted life-year gained. For older individuals, estimated ICERs for all health outcomes were below $10,000 per unit outcome gained for a 15-year time horizon. CONCLUSIONS Using population-based data, CHOP-R was found to be a cost-effective alternative to CHOP, particularly for individuals aged 60 years and older. Results from this Canadian observational data source were consistent with international clinical trial-based studies. The use of CHOP-R as a first-line treatment for DLBCL is recommended, with respect to both clinical and cost-effectiveness.
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Affiliation(s)
- Karissa M Johnston
- Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia Cancer Agency, Vancouver, BC, Canada
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17
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Ray JA, Carr E, Lewis G, Marcus R. An evaluation of the cost-effectiveness of rituximab in combination with chemotherapy for the first-line treatment of follicular non-Hodgkin's lymphoma in the UK. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:346-357. [PMID: 20070643 DOI: 10.1111/j.1524-4733.2009.00676.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES In this study, the cost-effectiveness of rituximab was evaluated in comparison with commonly used chemotherapy regimens for patients with advanced follicular lymphoma (FL), from the perspective of the UK National Health Service (NHS). METHODS Results from four randomized controlled trials comparing the addition of rituximab to chemotherapy regimens: mitoxantrone, chlorambucil, and prednisolone (MCP); cyclophosphamide, vincristine, and prednisolone (CVP); cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP); or cyclophosphamide, etoposide, doxorubicin, prednisolone, and interferon alpha (CHVP + IFNalpha) versus chemotherapy alone were used to develop a Markov model. The rates of disease progression and the duration of treatment effect were obtained from the trial data. Treatments were compared in two ways: 1) an individual comparison of rituximab + chemotherapy versus chemotherapy and 2) a multiple treatment comparison using league tables. Economic and clinical outcomes (quality-adjusted life-years (QALYs)) were estimated over patient lifetimes and discounted at 3.5% per annum. RESULTS In the individual comparison, the addition of rituximab increased QALYs by (mean, 95% confidence interval) 1.174 (1.02-1.30), 0.909 (0.79-1.01), 0.823 (0.71-0.91), and 0.453 (0.40-0.50) for MCP, CVP, CHOP, and CHVP, respectively, compared with chemotherapy alone. The incremental costs per QALY gained were pound7474, pound8621, pound10,732, and pound8551, respectively. Sensitivity analyses indicated that rituximab plus chemotherapy was a cost-effective treatment option, with incremental cost-effectiveness ratios below a threshold of pound30,000 per QALY gained. When compared across the chemotherapy regimens, rituximab plus MCP appeared to be the single most cost-effective treatment option, but further randomized trials are required to substantiate this. CONCLUSIONS The addition of rituximab to chemotherapy in advanced FL was found to be highly cost-effective in the UK.
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Pickard AS, Shaw JW, Lin HW, Trask PC, Aaronson N, Lee TA, Cella D. A patient-based utility measure of health for clinical trials of cancer therapy based on the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:977-988. [PMID: 19402850 DOI: 10.1111/j.1524-4733.2009.00545.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) is a widely used quality-of-life measure in oncology. The ability to translate QLQ-C30 responses into utility scores would further expand its use in medical decision-making. The aims of this study were to: 1) map QLQ-C30 responses onto patient time trade-off utility scores; and 2) compare a multiattribute approach to a global evaluation approach to modeling utility scores. METHODS Two distinct approaches were applied to data from 1432 cancer patients. The multiattribute approach used psychometric analysis and expert input to select a subset of functioning and symptom scale items for modeling. The second approach focused on global health and quality-of-life items based on a conceptual model. Model selection criteria included parsimony, statistical significance and logical consistency of parameter estimates, predictive accuracy, number of states described, and scale range. RESULTS The optimal multiattribute model included nine variables for five items from different scales, described 144 unique states, predicted values ranging from 0.63 to 1.00, but it had poor predictive accuracy (cross-validation pseudo-R(2) = 0.056). The best-fitting global approach-based model described 24 unique states using eight indicators for two items from one scale (plus a constant) and predicted values ranging from 0.17 to 1.00 (cross-validation pseudo-R(2) = 0.127). CONCLUSIONS Multiattribute models produced a greater number of unique predicted values, while global models exhibited more desirable statistical properties and a wider range of values. The recommended models will enable users to predict cancer patients' utilities from existing and future QLQ-C30 data sets.
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Affiliation(s)
- A Simon Pickard
- Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612-7230, USA.
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19
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Wilson KS, Sehn LH, Berry B, Chhanabhai M, Fitzgerald CA, Gill KK, Klasa R, Skinnider B, Sutherland J, Connors JM, Gascoyne RD. CHOP-R therapy overcomes the adverse prognostic influence of BCL-2 expression in diffuse large B-cell lymphoma. Leuk Lymphoma 2009; 48:1102-9. [PMID: 17577773 DOI: 10.1080/10428190701344881] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BCL-2 protein expression correlates with shorter survival in patients with diffuse large B cell lymphoma (DLBCL) who are treated with CHOP chemotherapy. We report a retrospective analysis of the prognostic significance of BCL-2 status in patients who received CHOP with the addition of rituximab (CHOP-R) for DLBCL. Patients over 15 years of age with de novo, HIV negative DLBCL, without CNS involvement, and known BCL-2 protein status were identified from the BCCA Lymphoid Cancer Database. BCL-2 tumour positivity was defined as over 50% of tumour cells with BCL-2 protein expression. 140 patients who received CHOP-R were analysed. The majority (59%) of patients were over 60 years of age. Disease stage distribution was limited (22%) and advanced (78%). BCL-2 protein expression was observed in 90 (64%) cases. IPI score was similar in both BCL-2 positive and negative cases. Median follow-up time for living patients is 40 months. BCL-2 status did not predict for either progression-free or overall survival. IPI score was predictive for progression-free survival but not overall survival. The addition of rituximab to CHOP chemotherapy negates the adverse prognostic influence of BCL-2 protein expression on progression free and overall survival in DLBCL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Gene Expression Regulation, Leukemic
- Genes, bcl-2
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/mortality
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Middle Aged
- Prednisone/therapeutic use
- Prognosis
- Retrospective Studies
- Rituximab
- Survival Analysis
- Treatment Outcome
- Vincristine/therapeutic use
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Affiliation(s)
- Kenneth S Wilson
- Department of Medical Oncology, Vancouver Island Centre, University of British Columbia, BC, Canada.
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The cumulative burden of oral corticosteroid side effects and the economic implications of steroid use. Respir Med 2009; 103:975-94. [PMID: 19372037 DOI: 10.1016/j.rmed.2009.01.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 12/19/2008] [Accepted: 01/05/2009] [Indexed: 11/22/2022]
Abstract
Oral corticosteroids (OCS) are a key part of therapy regimens for a diverse variety of conditions. Despite their efficacy, they are associated with a wide variety of adverse events. The purpose of this review was to identify the range of adverse events that have been reported to be related to oral corticosteroids, examine the factors that influence their incidence and estimate the economic burden caused by these adverse events. In 61 identified studies, 21 different categories of OCS related adverse events were reported with increased fracture risk being the category most frequently described. Most studies that examined factors linked to the incidence of OCS related adverse events found that dose, age, gender, duration of use, treatment history, smoking habits or cholesterol level were influential in determining risk. Additionally, a cumulative economic analysis of selected adverse events found the annual cost of treating these events in the UK to be at least 165 pounds per patient taking OCS. The clinical and economic burden of OCS related adverse events highlights the need for OCS sparing therapies to be developed.
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Andhavarapu S, Tolentino AM, Jha C, Ravi J, Carlson R, Nair GR. Diffuse Large B-Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis of the Gastrointestinal Tract. ACTA ACUST UNITED AC 2008; 8:179-83. [DOI: 10.3816/clm.2008.n.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee RC, Zou D, Demetrick DJ, Difrancesco LM, Fassbender K, Stewart D. Costs associated with diffuse large B-cell lymphoma patient treatment in a Canadian integrated cancer care center. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:221-30. [PMID: 18380634 DOI: 10.1111/j.1524-4733.2007.00227.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The objective of this study was to provide a detailed comparative microcosting analysis for two cancer treatment pathways to contribute evidence for resource allocation and operational decision-making in a Canadian cancer care context. METHODS We estimated direct medical costs (in 2004 CAN$) of the entire pathway of care for diffuse large B-cell lymphoma (DLBCL) patients in a large Canadian cancer treatment center. Patient samples were defined as those who received R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone; n = 85) or CHOP (i.e., without rituximab; n = 86) as first-line treatment. All subsequent treatments including palliative care for these patient samples were assessed. Hospitalization costs and unit costs of medical resources were collected from integrated medical organizations. Individual patient resource consumption was assessed via medical chart review. RESULTS For first-line treatment, drug cost was the largest contributor to total cost, followed by hospitalization cost. Rituximab was the largest contributor to mean cost differences between R-CHOP and CHOP treatments. For treatments subsequent to first-line treatment, no significant cost differences were found. Hospitalization and transplantation costs were the two largest constituents of total costs subsequent to first-line treatment, followed by drug cost. Patients with advanced stage disease cost significantly more than patients with limited stage disease. CONCLUSION This is the first detailed microcosting study that has employed consistent local data to estimate total medical costs for DLBCL patients in Canada. This information is useful for resource allocation planning and operational decisions, because it provides more substantive, relevant evidence as compared to aggregated, literature or extrapolated information.
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Affiliation(s)
- Robert C Lee
- University of Calgary Department of Community Health Sciences, Calgary, AB, Canada
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23
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Ferrara F, Ravasio R. Cost-Effectiveness Analysis of the??Addition of Rituximab to CHOP??in Young Patients with Good-Prognosis Diffuse Large-B-Cell Lymphoma. Clin Drug Investig 2008; 28:55-65. [DOI: 10.2165/00044011-200828010-00007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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García-Suárez J, Bañas H, Arribas I, De Miguel D, Pascual T, Burgaleta C. Dose-adjusted EPOCH plus rituximab is an effective regimen in patients with poor-prognostic untreated diffuse large B-cell lymphoma: results from a prospective observational study. Br J Haematol 2007; 136:276-85. [PMID: 17233819 DOI: 10.1111/j.1365-2141.2006.06438.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study was designed to assess the efficacy and safety of an infusional DA-EPOCH (dose-adjusted etoposide/vincristine/doxorubicin/bolus cyclophosphamide/prednisone) and rituximab (DA-EPOCH-R) regimen for patients with poor prognosis diffuse large B-cell lymphoma (DLBCL). Thirty-three patients, aged 21-76 years, with an age-adjusted International Prognostic Index (IPI) of 2 or 3, were enrolled, and 31/33 patients were evaluable for response. Consolidative radiation therapy was given to eight patients with bulky (> or =10 cm) disease at presentation. Overall, 26 patients (83.8%) achieved a complete remission (CR), four patients (12.9%) achieved a partial remission, and one patient (3.2%) died during induction. Two patients relapsed (7.6%) within 15 months. Grade 3-4 neutropenia developed in 52% of cycles and neutropenic fever in 14% of cycles (51% of patients). The estimates for event-free survival (EFS) and overall survival at 2 years were 68% and 75% respectively. The only factor related to poor EFS was the presence of three age-adjusted IPI-risk factors. We conclude that DA-EPOCH-R has clinically significant activity with a favourable toxicity profile for poor-prognostic DLBCL patients. The administration of DA-EPOCH-R as an outpatient regimen by using a single portable infusion pump may be a feasible alternative to improve the compliance and to reduce the total cost of this very effective regimen.
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Affiliation(s)
- Julio García-Suárez
- Service of Haematology, Department of Medicine, Príncipe de Asturias University Hospital, University of Alcalá, Alcalá de Henares, Madrid, Spain. jgarciasu@
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25
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Rituximab in lymphoma: a systematic review and consensus practice guideline from Cancer Care Ontario. Cancer Treat Rev 2007; 33:161-76. [PMID: 17240533 DOI: 10.1016/j.ctrv.2006.10.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 10/24/2006] [Accepted: 10/24/2006] [Indexed: 11/28/2022]
Abstract
Rituximab is the first antibody-based therapy approved in cancer. The role of this treatment for non-Hodgkin's lymphoma has evolved significantly since its introduction. We aimed to systematically review the literature on rituximab in non-Hodgkin's lymphoma and provide consensus guidelines as to the rational use of this agent. Validated methodology from the Cancer Care Ontario Program in Evidence-Based Care was applied. A comprehensive literature search was completed by reviewers from the Hematology Disease Site Group of Cancer Care Ontario. Data were abstracted from randomized controlled trials of rituximab-containing regimens for patients with non-Hodgkin's lymphoma. Twenty-three randomized controlled trials (RCTs) of rituximab-based therapy were analyzed. Consistent and clinically important benefits in progression-free and overall survival and were seen in the following settings: (1) addition of rituximab to combination chemotherapy for initial treatment of diffuse large B-cell lymphoma and other aggressive B-cell lymphomas; (2) addition of rituximab to combination chemotherapy for initial and subsequent treatment of follicular lymphoma and other indolent B-cell lymphomas; and (3) use of rituximab alone as extended maintenance therapy in patients with indolent B-cell lymphomas who have responded to initial treatment. The consensus opinion of the Hematology Disease Site Group is that rituximab is recommended for these indications.
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26
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Held G, Pöschel V, Pfreundschuh M. Rituximab for the treatment of diffuse large B-cell lymphomas. Expert Rev Anticancer Ther 2006; 6:1175-86. [PMID: 16925484 DOI: 10.1586/14737140.6.8.1175] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For more than 25 years, the combination of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) was considered the gold standard for the treatment of aggressive lymphomas, 90% of which are diffuse, large B-cell lymphomas (DLBCLs). Attempts to improve results by more intensive chemotherapy regimens, including high-dose chemotherapy approaches necessitating stem-cell support, have not convincingly shown improved outcome of DLBCL. The chimeric monoclonal antibody rituximab, which binds to the CD20 antigen expressed on normal B cells and the malignant cells of more than 90% of DLBCLs, and mediates lysis of these cells by direct induction of apoptosis, activation of complement- and antibody-dependent cellular cytotoxicity in vitro, is an attractive candidate for the treatment of B-cell lymphomas. Initial studies in follicular lymphoma demonstrated its efficacy as a single agent or in combination with chemotherapy without adding relevant toxicity. After the demonstration of rituximab single-agent activity in DLBCL, a pivotal trial in elderly patients demonstrated that combining rituximab with eight applications of CHOP significantly improved complete remission, event-free and overall survival rates when compared with CHOP alone. These positive results have meanwhile been confirmed by two additional randomized trials in elderly patients and have been extended to young patients with good-prognosis DLBCL by a fourth trial. While not yet formally established in young, poor-prognosis patients, rituximab in combination with CHOP has become accepted worldwide as the new standard for the treatment of DLBCL. Questions remain concerning the optimal dosage and schedule of rituximab for DLBCL, as well as the optimal chemotherapy regimen partner for rituximab. Rituximab is the first monoclonal antibody to consistently improve survival rates of patients with a malignant disease. Its excellent efficacy in combination with cytotoxic chemotherapy, together with its favorable toxicity profile, establishes rituximab as an indispensable component of modern standard immunochemotherapy of DLBCL.
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Affiliation(s)
- Gerhard Held
- Klinik für Innere Medizin I, Saarland University Medical School, D-66421 Homburg, Saar, Germany.
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Cvetković RS, Perry CM. Rituximab: a review of its use in non-Hodgkin's lymphoma and chronic lymphocytic leukaemia. Drugs 2006; 66:791-820. [PMID: 16706552 DOI: 10.2165/00003495-200666060-00005] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Rituximab (MabThera, Rituxan) is an anti-CD20 monoclonal antibody that induces lysis and apoptosis of normal and malignant human B cells, and sensitises malignant B cells to the cytotoxic effect of chemotherapy. In phase III trials in patients with indolent or aggressive B-cell non-Hodgkin's lymphoma (NHL), intravenous rituximab in combination with chemotherapy was more effective as first- or second-line therapy than chemotherapy alone in providing tumour remission and patient survival. Likewise, in patients with chronic lymphocytic leukaemia (CLL), rituximab in combination with chemotherapy appeared more effective than chemotherapy alone as either first- or second-line treatment. In addition, rituximab maintenance therapy was shown to significantly prolong tumour remission and patient survival in patients with indolent B-cell NHL or CLL. The combination of rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) was cost effective as first-line therapy for advanced-stage diffuse large B-cell NHL compared with CHOP alone. Rituximab, either alone or in combination with chemotherapy, was generally well tolerated in patients with NHL or CLL. Overall, rituximab in combination with chemotherapy, is a valuable option for first- and second-line therapy in patients with advanced-stage indolent or aggressive B-cell NHL, and possibly those with B-cell CLL, and is included in current treatment guidelines for these indications. The drug is also potentially useful as maintenance therapy in patients with indolent B-cell NHL or CLL.
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Affiliation(s)
- Risto S Cvetković
- Adis International Limited, 41 Centorian Drive, Mairangi Bay, Auckland 1311, New Zealand.
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Schmitz S, Aly F, Steinmetz T, Diehl V, Rehwald U. Sensitivity analysis of cost factors for various therapy options in the treatment of follicular lymphoma. Oncol Res Treat 2006; 29:258-64. [PMID: 16770087 DOI: 10.1159/000093312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In Germany, patients with relapsed follicular non-Hodgkin's lymphoma do not all receive the same treatment. In this study, 3 therapy regimens were analyzed which were considered to be similar. With the goal of determining the treatment option with the lowest direct costs whilst maintaining the same degree of effectiveness, a cost analysis model was established and applied by way of example to the existing illness constellation. METHODS The German doctors' fee scale (Einheitlicher Bewertungsmassstab, EBM) valid until 2005 served as the basis for the calculation of medical services within the scope of the present statutory health insurance guidelines. A virtual standard patient was constructed for the cost model and treated with the different therapy regimens. The incidences of individual adverse events described in literature served as the basis for the characterization of the average toxicity of the respective treatment methods. RESULT The overall costs result from the sum of the treatment costs and the toxicity-related costs. The effect of additional interventions on the overall cost was also examined. CONCLUSION Whereas the accompanying documentation of costs in clinical studies is organizationally complex and very tedious, the model applied here offers a reliable method of quantifying the costs of the different therapy regimens. It permits the comparison of different treatment alternatives, and it enables, by means of a cost variance analysis, the identification of cost drivers and less expensive measures within a therapy method.
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Affiliation(s)
- Stephan Schmitz
- Hemato-Oncological Group Practice, University Hospital, Sachsenring 69, 50677 Cologne (Köln), Germany.
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