Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma


  • John C. Hornberger M.D., M.S.,

    Corresponding author
    1. Department of Clinical Economics, Acumen LLC/The SPHERE Institute, Burlingame, California
    2. Department of Medicine, Department of Veteran Affairs, Palo Alto, California
    3. Department of Medicine, Stanford University, Stanford, California
    • 1415 Rollins Road, Suite 110, Burlingame, CA 94010
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    • Dr. Hornberger's recent and current funding includes projects sponsored by county, state, and federal government agencies (National Institutes of Health, Agency for Health Research and Quality, Department of Veterans Affairs, Health Resources and Services Administration, and the U.S. Office of Technology Assessment), professional medical societies (Renal Physicians Association), nonprofit agencies and foundations (Picker Foundation and Salt Lake City Health Access Program), and for-profit companies (Roche Pharmaceuticals, Roche Laboratories, and Genentech, Inc.).

    • Fax: (550) 558-0180

  • Jennie H. Best M.A.

    1. Department of Pharmacy, Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington
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  • The development of the model and the subsequent analyses were supported by a grant from Genentech, Inc. The sponsors of the study had no role in the model design, cost-utility analysis, or interpretation of the results. All investigators had unlimited access to the model and data. No limitations on publication were imposed. The authors made the final decisions on all analyses presented in the article.



Findings from the Groupe d'Etude des Lymphomes Adultes LNH 98-5 study showed that rituximab added to combined cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) prolonged progression-free survival and overall survival in adults age ≥ 60 years with diffuse large B-cell non-Hodgkin lymphoma (DLBCL). The current study was conducted to investigate the incremental cost utility of the addition of rituximab to CHOP (R-CHOP) compared with CHOP alone.


Clinical prognosis of the time to disease progression and death was estimated using published evidence from the LNH 98-5 study (n = 399 patients) that was linked mathematically to published long-term outcome data on patients with DLBCL. Drug-acquisition costs were based on published data from formulary pricing sources, and the costs of cancer surveillance and end-of-life care were based on published literature sources. The authors assessed cost utility as the difference in costs between R-CHOP and CHOP divided by the increase in expected overall survival adjusted for quality of life.


Over 5 years, it was projected that R-CHOP would prolong overall survival by 1.04 years. The mean cumulative cost of CHOP was $3358, and the mean cost of R-CHOP was $17,225, resulting in a cumulative net increase of $13,867. The posttreatment cancer surveillance cost for CHOP was $3950, compared with $5202 for R-CHOP. It was estimated that R-CHOP would have a cost-utility ratio of $19,297 per year of life gained compared with CHOP when adjusted for quality of life. R-CHOP remained cost effective over wide ranges of variables in sensitivity analyses.


Compared with CHOP alone, it was predicted that R-CHOP would be cost effective in elderly patients with DLBCL. Cancer 2005. © 2005 American Cancer Society.