nach oben

PharmacoEconomics

Erschienen in:

01.01.2010 | Original Research Article

Cost Effectiveness of Rituximab Maintenance Therapy in Follicular Lymphoma

Long-Term Economic Evaluation

verfasst von: Eric Deconinck, Dr Houda Miadi-Fargier, Claude Le Pen, Pauline Brice

Erschienen in: PharmacoEconomics | Ausgabe 1/2010

Einloggen, um Zugang zu erhalten

Abstract

Background: Rituximab maintenance therapy was shown to significantly extend overall survival (OS) and progression-free survival (PFS) in relapsed/refractory follicular lymphoma (FL) in the pivotal EORTC 20981 trial.

Objective: To assess the long-term costs and cost effectiveness of rituximab maintenance therapy after induction therapy versus current standard practice (observation) from the French National Health Service perspective.

Methods: A lifetime transition model was developed comparing rituximab maintenance with observation. PFS and OS were obtained from the EORTC 20981 trial with a median follow-up of 28 months and extrapolated from 2-year Kaplan-Meier curves using a Weibull distribution. PFS and OS benefits of rituximab were conservatively assumed to last only 5 years. Utility data were obtained from a multicentre observational study using the EQ-5D questionnaire. Direct medical costs were obtained from French official sources. All costs are reported in €, year 2006 values.

Results: The EORTC 20981 study demonstrated that rituximab maintenance was effective in the management of relapsed/refractory FL. The model results showed that life expectancy and QALYs were increased by 22% and 28%, respectively, in patients treated with rituximab. The incremental cost-effectiveness ratios (ICERs) were €7612 per life-year gained and €8729 per QALY gained. In a oneway sensitivity analysis,most of the ICERs fell within the range of €7000–12 000.

Conclusion: The results tend to show that rituximab maintenance therapy may be a cost-effective strategy in the management of relapsed/refractory FL in France, with ICERs below those observed for other therapies in the oncology field. The cost of rituximab was partly offset by the lower cost of relapse due to a longer time in the disease-free health state for patients in the rituximab arm.

Nur mit Berechtigung zugänglich

Solal-Celigny P, Colombat P. Lymphomes non hodgkiniens de faible malignité. In: Andrieu JM, Colonna P, editors. Cancers: évaluation, traitement et surveillance. Paris: ESTEM, 1997

French Society of Hematology. Follicular lymphoma. Ré — férentiels 2006 [online]. Available from URL: http://sfh.hematologie.net [Accessed 2007 Jan 31]

Remontet L, Estève J, Bouvier AM, et al. Cancer incidence and mortality in France over the period 1978–2000. Rev Epidemiol Sante Publique 2003; 51: 3–30PubMed

Haute Autorité de Santé. Avis de la Commission de la Transparence: Mabthera® — 8 Novembre 2006 [online]. Available from URL: http://www.has-sante.fr [Accessed 2007 Jan 31]

Van Oers MH, Klasa R, Marcus RE, et al. Rituximab maintenance improves clinical outcome of relapsed/resistant follicular non-Hodgkin lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood 2006; 15: 3295–301CrossRef

Kasteng F, Erlanson M, Hagberg H, et al. Cost-effectiveness of maintenance rituximab treatment after second line therapy in patients with follicular lymphoma in Sweden. Acta Oncol 2008; 47 (6): 1029–36CrossRef

French Health Economists Association. French guidelines for the economic evaluation of health care technologies: methodological recommendations 2004 [online]. Available from URL: http://www.ces-asso.org [Accessed 2007 Jan 31]

EORTC 20981: Clinical study report. EORTC 20981 (M39022): chimeric anti-CD20 monoclonal antibody (MabThera) in remission induction and maintenance treatment of relapsed follicular non-Hodgkin’s lymphoma. A phase III randomized clinical trial: Intergroup Collaborative Study [research report 1016350, 2005 Dec]

Hosmer Jr DW, Lemeshow S. Descriptive methods for survival data. In: Barnett V, Cressie NAC, Fisher NI, et al, editors. Applied survival analysis: regression modeling of time to event data. New York: John Wiley & Sons Inc, 1999: 27–86

10.

Keith RA. Regression models for survival data. In: Everitt BS, Dunn G, editors. Statistical analysis of medical data: new developments. London: Arnold, 1998: 315–28

11.

Wild D, Walker M, Pettengell R, et al. Utility elicitation in patients with follicular lymphoma [abstract no. PCN62]. Value Health 2006; 9: A294. Plus poster presented at the International Society For Pharmacoeconomics and Outcomes Research [ISPOR] 9th Annual European Congress; 2006 Oct 28–31; CopenhagenCrossRef

12.

Observational study on prescription habits in follicular lymphoma in France. Paris: TNS Healthcare, 2006

13.

Deconinck E, Foussard C, Milpied N, et al. High-dose therapy followed by autologous purged stem-cell transplantation and doxorubicin-based chemotherapy in patients with advanced follicular lymphoma: a randomized multicenter study by GOELAMS. Blood 2005; 15: 3817–23CrossRef

14.

Agence Technique de l’Information sur l’Hospitalisation [online]. Available from URL: http://www.atih.sante.fr/ [Accessed 2006 Dec 31]

15.

l’Assurance Maladie [online]. Available from URL: http://www.ameli.fr [Accessed 2006 Dec 31]

16.

VIDAL [online]. Available from URL: http://www.vidal.fr [Accessed 2006 Dec 31]

17.

Czuczman MS, Koryzna A, Mohr A, et al. Rituximab in combination with fludarabine chemotherapy in low-grade or follicular lymphoma. J Clin Oncol 2005; 1: 694–704CrossRef

18.

Velasquez WS, McLaughlin P, Tucker S, et al. ESHAP: an effective chemotherapy regimen in refractory and relapsing lymphoma. A 4-year follow-up study. J Clin Oncol 1994; 12: 1169–76CrossRef

19.

Bos JM, Postma MJ, Annemans L. Discounting health effects in pharmacoeconomic evaluations: current controversies. Pharmacoeconomics 2005; 23 (7): 639–49CrossRef

20.

Smith DH, Adams JR, Johnston SR, et al. A comparative economic analysis of pegylated liposomal doxorubicin versus topotecan in ovarian cancer in the USA and the UK. Ann Oncol 2002 Oct; 13 (10): 1590–7CrossRef

21.

The French National Cancer Institute. The economic evaluation of cancer in France [online]. Available from URL: http://www.e-cancer.fr [Accessed 2007 Jul 31]

22.

Moatti JP, Le Corroller Soriano AG, Protière C. The “Plan Cancer” in France: an economists’ point of view. Bull Cancer 2003; 90: 1010–5PubMed

23.

WHO Commission on Macroeconomics and Health. Macroeconomics and health: investing in health for economic development. Report of the Commission on Macroeconomics and Health. Geneva: WHO, 2001 [online]. Available from URL: http://www.paho.org/English/HDP/HDD/Sachs.pdf [Accessed 2007 Jan 31]

24.

Organisation for Economic Co-operation and Developement. Statistics and indicators for 30 countries [CD ROM]. Paris: Health Data, 2006

25.

Devlin N, Parkin D. Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Econ 2004; 13: 437–52CrossRef

26.

National Institute for Health and Clinical Excellence. Final appraisal determination: bortezomib monotherapy for relapsed multiple myeloma [online]. Available from URL: http://guidance.nice.org.uk [Accessed 2007 Jul 31]

27.

Brice P, Simon D, Bouabdallah R, et al. High-dose therapy with autologous stem-cell transplantation (ASCT) after first progression prolonged survival of follicular lymphoma patients included in the prospective GELF 86 protocol. Ann Oncol 2000; 11: 1585–90CrossRef

28.

Westerman IL, Bennett CL. A review of the costs, costeffectiveness and third-party charges of bone marrow transplantation. Stem Cells 1996; 14: 312–9CrossRef

29.

Lee SJ, Anasetti C, Kuntz KM, et al. The costs and costeffectiveness of unrelated donor bone marrow transplantation for chronic phase chronic myelogenous leukemia. Blood 1998; 1: 4047–52CrossRef

Titel: Cost Effectiveness of Rituximab Maintenance Therapy in Follicular Lymphoma
Long-Term Economic Evaluation
verfasst von: Eric Deconinck
Dr Houda Miadi-Fargier
Claude Le Pen
Pauline Brice
Publikationsdatum: 01.01.2010
Verlag: Springer International Publishing
Erschienen in: PharmacoEconomics / Ausgabe 1/2010
Print ISSN: 1170-7690
Elektronische ISSN: 1179-2027
DOI: https://doi.org/10.2165/11314070-000000000-00000

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2010

The Cost and Incidence of Prescribing Errors Among Privately Insured HIV Patients

Adverse Drug Interactions

Cost Effectiveness of Intensive Lipid-Lowering Treatment for Patients with Congestive Heart Failure and Coronary Heart Disease in the US

Should Financial Incentives be Used to Differentially Reward ‘Me-Too’ and Innovative Drugs?

Erlotinib

A Policy Model to Evaluate the Benefits, Risks and Costs of Warfarin Pharmacogenomic Testing