Anca Prica1, Kelvin Chan2, Matthew Cheung3. 1. Division of Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada. 2. Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 3. Division of Hematology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: A watch and wait (WW) strategy is the standard of care for patients with asymptomatic advanced-stage follicular lymphoma. Recent data have demonstrated an improvement in the time to progression with rituximab induction (RI) with or without rituximab maintenance (RM) in comparison with a WW strategy wait in such patients. It remains unclear whether this is a cost-effective strategy. METHODS: A Markov decision analysis model was developed to compare the clinical outcomes, costs, and cost-effectiveness of RI (4 weekly doses) plus RM (12 doses every 2 months), RI (4 weekly doses), and a WW strategy for patients newly diagnosed with low-burden, asymptomatic advanced-stage follicular lymphoma over a lifetime horizon. Baseline probabilities and utilities were derived from a systematic review of published studies, and they were evaluated on a 6-month cycle. A Canadian public health payer's perspective was adopted, and costs were presented in 2012 Canadian dollars. RESULTS: RI was the cheapest strategy. It was less costly at $59,953 versus $67,489 for the RM arm and $75,895 for the WW arm. It was also associated with a slightly lower quality-adjusted life expectancy at 6.16 quality-adjusted life years (QALYs) versus 6.28 QALYs for the RM strategy but was superior to WW (5.71 QALYs). In sensitivity analyses of key variables, this effectiveness was sensitive to the probability of first and second progression in the RI arm, and this indicated relatively neutral effectiveness between the 2 rituximab arms. CONCLUSIONS: RI without maintenance for asymptomatic advanced-stage follicular lymphoma is the preferred strategy: it minimizes costs per patient over a lifetime horizon.
BACKGROUND: A watch and wait (WW) strategy is the standard of care for patients with asymptomatic advanced-stage follicular lymphoma. Recent data have demonstrated an improvement in the time to progression with rituximab induction (RI) with or without rituximab maintenance (RM) in comparison with a WW strategy wait in such patients. It remains unclear whether this is a cost-effective strategy. METHODS: A Markov decision analysis model was developed to compare the clinical outcomes, costs, and cost-effectiveness of RI (4 weekly doses) plus RM (12 doses every 2 months), RI (4 weekly doses), and a WW strategy for patients newly diagnosed with low-burden, asymptomatic advanced-stage follicular lymphoma over a lifetime horizon. Baseline probabilities and utilities were derived from a systematic review of published studies, and they were evaluated on a 6-month cycle. A Canadian public health payer's perspective was adopted, and costs were presented in 2012 Canadian dollars. RESULTS: RI was the cheapest strategy. It was less costly at $59,953 versus $67,489 for the RM arm and $75,895 for the WW arm. It was also associated with a slightly lower quality-adjusted life expectancy at 6.16 quality-adjusted life years (QALYs) versus 6.28 QALYs for the RM strategy but was superior to WW (5.71 QALYs). In sensitivity analyses of key variables, this effectiveness was sensitive to the probability of first and second progression in the RI arm, and this indicated relatively neutral effectiveness between the 2 rituximab arms. CONCLUSIONS: RI without maintenance for asymptomatic advanced-stage follicular lymphoma is the preferred strategy: it minimizes costs per patient over a lifetime horizon.
Authors: Nathan H Fowler; Guifang Chen; Stephen Lim; Stephanie Manson; Qiufei Ma; Frank Yunfeng Li Journal: J Health Econ Outcomes Res Date: 2020-09-04
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: Han-I Wang; Eve Roman; Simon Crouch; Eline Aas; Cathy Burton; Russell Patmore; Alexandra Smith Journal: Value Health Date: 2018-04-24 Impact factor: 5.725
Authors: Andrea C Lo; Lyndon P James; Anca Prica; Adam Raymakers; Stuart Peacock; Melody Qu; Alex V Louie; Kerry J Savage; Laurie H Sehn; David Hodgson; Joanna C Yang; Hans T T Eich; Andrew Wirth; M G Myriam Hunink Journal: J Nucl Med Date: 2021-08-19 Impact factor: 10.057
Authors: Ali Tafazzoli; Scott D Ramsey; Alissa Shaul; Ameya Chavan; Weicheng Ye; Anuraag R Kansal; Josh Ofman; A Mark Fendrick Journal: Pharmacoeconomics Date: 2022-08-30 Impact factor: 4.558
Authors: Caitlin Eichten; Qiufei Ma; Thomas E Delea; May Hagiwara; Roberto Ramos; Şerban R Iorga; Jie Zhang; Richard T Maziarz Journal: Pharmacoeconomics Date: 2021-07-17 Impact factor: 4.981