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Greuter M, Eertink JJ, Jongeneel G, Dührsen U, Hüttmann A, Schmitz C, Lugtenburg PJ, Barrington SF, Mikhaeel NG, Ceriani L, Zucca E, Carr R, Györke T, Burggraaff CN, de Vet H, Hoekstra OS, Zijlstra JM, Coupé V. Cost-Effectiveness of Shortening Treatment Duration Based on Interim PET Outcome in Patients With Diffuse Large B-cell Lymphoma. Clin Lymphoma Myeloma Leuk 2022; 22:382-392. [PMID: 34953740 DOI: 10.1016/j.clml.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Guideline recommendations for diffuse large-B-cell lymphoma (DLBCL) treatment are shifting from long to short treatment duration, although it is still unclear whether shortening treatment duration does not cause any harm. As interim PET (I-PET) has high negative predictive value for progression, we evaluated the cost-effectiveness of shortening treatment duration dependent on I-PET result. MATERIALS AND METHODS We developed a Markov cohort model using the PET Re-Analysis (PETRA) database to evaluate a long treatment duration (LTD) strategy, ie 8x R-CHOP or 6x R-CHOP plus 2 R, and a short treatment duration (STD) strategy, ie 6x R-CHOP. Strategies were evaluated separately in I-PET2 positive and I-PET2 negative patients. Outcomes included total costs and quality-adjusted life-years (QALYs) per patient (pp) from a societal perspective. Net monetary benefit (NMB) per strategy was calculated using a willingness-to-pay threshold of €50,000/QALY. Robustness of model predictions was assessed in sensitivity analyses. RESULTS In I-PET2 positive patients, shortening treatment duration led to 50.4 additional deaths per 1000 patients. The STD strategy was less effective (-0.161 [95%CI: -0.343;0.028] QALYs pp) and less costly (-€2768 [95%CI: -€8420;€1105] pp). Shortening treatment duration was not cost-effective (incremental NMB -€5281). In I-PET2 negative patients, shortening treatment duration led to 5.0 additional deaths per 1000 patients and a minor difference in effectiveness (-0.007 [95%CI: -0.136;0.140] QALY pp). The STD strategy was less costly (-€5807 [95%CI: -€10,724;-€2685] pp) and led to an incremental NMB of €5449, indicating that it is cost-effective to shorten treatment duration. Robustness of these findings was underpinned by deterministic and probabilistic sensitivity analyses. CONCLUSION Treatment duration should not be shortened in I-PET2 positive patients whereas it is cost-effective to shorten treatment duration in I-PET2 negative patients.
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Affiliation(s)
- Mje Greuter
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands..
| | - J J Eertink
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - G Jongeneel
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - U Dührsen
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - A Hüttmann
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - C Schmitz
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - P J Lugtenburg
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, department of Hematology, The Netherlands
| | - S F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's Health Partners, Kings College London, London, United Kingdom
| | - N G Mikhaeel
- Department of Clinical Oncology, Guy's Cancer Centre and King's College London University, London, United Kingdom
| | - L Ceriani
- Department of Nuclear Medicine and PET/CT Centre, IIMSI - Imaging Institute of Southern Switzerland, Bellinzona, Switzerland;; SAKK - Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - E Zucca
- SAKK - Swiss Group for Clinical Cancer Research, Bern, Switzerland; Medical Oncology Clinics, IOSI - Oncology Institute of Southern Switzerland, Bellinzona; Università della Svizzera Italiana, Bellinzona, Switzerland
| | - R Carr
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust and Cancer Division, Kings College London, London, United Kingdom
| | - T Györke
- Department of Nuclear Medicine, Semmelweis University, Budapest, Hungary
| | - C N Burggraaff
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hcw de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Vmh Coupé
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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Roos C, Van den Bogaard V, Greuter M, Vliegenthart R, Schuit E, Langendijk J, Van der Schaaf A, Crijns A, Maduro J. OC-0091: Prognostic value of calcium score in breast cancer patients treated with radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30401-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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