Cost-Effectiveness Analysis of Rituximab Combined with CHOP for Treatment of Diffuse Large B-Cell Lymphoma
Article first published online: 20 JUL 2005
Value in Health
Volume 8, Issue 4, pages 462–470, July 2005
How to Cite
Best, J. H., Hornberger, J., Proctor, S. J., Omnes, L. F. and Jost, F. (2005), Cost-Effectiveness Analysis of Rituximab Combined with CHOP for Treatment of Diffuse Large B-Cell Lymphoma. Value in Health, 8: 462–470. doi: 10.1111/j.1524-4733.2005.00037.x
- Issue published online: 20 JUL 2005
- Article first published online: 20 JUL 2005
- cost-effectiveness analysis;
Purpose: To estimate the cost-effectiveness from a French payer perspective of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) alone compared with CHOP plus rituximab (R-CHOP) for treatment of patients with diffuse large B-cell lymphoma.
Methods: Mean patient survival, days of hospitalization, and chemotherapy costs during treatment were estimated from a Phase III trial in France, Belgium, and Switzerland. Survival during the trial was estimated using the Kaplan–Meier method; survival beyond the trial period was projected based on mortality rates from the Scottish and Newcastle Lymphoma Group database. French diagnosis-related group (DRG) payment schedules were applied to trial data to estimate cost of adverse events and drug administration. We estimated survival and cost-effectiveness [the incremental cost per quality-adjusted life-year (QALY) gained] from 4 years (median clinical trial follow-up period) to 15 years, discounted at a fixed annual rate of 3%. We used published patient preferences. We converted currency to euros, based on 2003 exchange rates.
Results: R-CHOP resulted in a 20.6% relative increase in complete response rate (absolute increase from 63% to 76%), and a 31% decrease in risk of death at 4 years (95% CI 8–49%). Over a 15-year time horizon, mean overall survival (OS) duration was estimated to be 6.90 years for R-CHOP and 5.74 years for CHOP, a mean increase in OS of 1.16 years (or 1.07 QALYs). Total direct medical costs were €13,170 higher with R-CHOP, with an incremental cost-effectiveness ratio of €12,259 per QALY gained.
Conclusion: R-CHOP significantly increases mean OS up to 4 years compared with CHOP, and its cost-effectiveness ratio compares favorably with other oncology treatments in widespread use.