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.
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.
Authors: Sara Khor; Jaclyn Beca; Murray Krahn; David Hodgson; Linda Lee; Michael Crump; Karen E Bremner; Jin Luo; Muhammad Mamdani; Chaim M Bell; Carol Sawka; Scott Gavura; Terrence Sullivan; Maureen Trudeau; Stuart Peacock; Jeffrey S Hoch Journal: BMC Cancer Date: 2014-08-12 Impact factor: 4.430
Authors: Gilles Salles; Martin Barrett; Robin Foà; Joerg Maurer; Susan O'Brien; Nancy Valente; Michael Wenger; David G Maloney Journal: Adv Ther Date: 2017-10-05 Impact factor: 3.845
Authors: Dean A Regier; Brandon Chan; Sarah Costa; David W Scott; Christian Steidl; Joseph M Connors; Aly Karsan; Marco A Marra; Robert Kridel; Ian Cromwell; Samantha Pollard Journal: Cancers (Basel) Date: 2022-02-12 Impact factor: 6.639