Cost-Effectiveness Analyses, Costs and Resource Use, and Health-Related Quality of Life in Patients with Follicular or Marginal Zone Lymphoma: Systematic Reviews

Abstract

Background Follicular lymphoma (FL) and marginal zone lymphoma (MZL) are types of indolent non-Hodgkin lymphoma (NHL) that develop in the B lymphocytes (also known as B cells).Objective The aim of this study was to conduct a comprehensive review of studies relating to cost effectiveness, costs and resource use, and health-related quality of life (HRQoL) in patients with FL or MZL. Methods Three separate systematic reviews were conducted to identify all published evidence on cost effectiveness, costs and resource use, and HRQoL between 2007 and March 2017 using the MEDLINE ® , MEDLINE in-process, E-pubs ahead of print (Ovid SP ® ), Embase (Ovid SP ® ), NHS EED, and EconLit databases. Select congress proceedings were also searched. Two systematic reviewers independently reviewed titles, abstracts, and full papers against eligibility criteria. Relevant data were extracted into bespoke data extraction templates (DETs) by a single systematic reviewer; these data were then validated for accuracy by a second reviewer against clean copies of the relevant publications. Results A total of 25 cost-effectiveness studies (24 in FL; 1 in FL and MZL) met the eligibility criteria. Markov models were the most utilised cost-effectiveness model. US FL studies reported an incremental cost-effectiveness ratio (ICER) of $28,565/QALY for first-line rituximab-cyclophosphamide, vincristine, and prednisone (R-CVP) versus CVP, and $43,000/ QALY for second-line obinutuzumab plus bendamustine (G + B) followed by G maintenance versus B. In the UK, ICERs were £1529-10,834/quality-adjusted life-year (QALY) for first-line rituximab + chemotherapy versus chemotherapy, £27,988/ QALY for second-line G + B + G-maintenance versus B, and £62,653/QALY for second-line idelalisib versus chemotherapy and/or rituximab. Five costs/resource use and four HRQoL studies were identified in FL, and none in MZL. US mean lifetime costs in first-line patients ranged from $108,000 (rituximab) to $130,300 (rituximab-cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone [CHOP]), and from £2185 (watch-and-wait) to £17,054 (chemotherapy) in the UK. In a multinational study, more rituximab-refractory patients receiving G + B + G-maintenance reported a meaningful improvement in total FACT-Lym scores compared with patients receiving B. In the UK, total FACT-Lym scores were meaningfully higher for newly diagnosed patients compared with patients with progression (136.04 vs. 109.7). Conclusions and RelevanceWe found a small body of evidence of quality of life, and potentially cost-effective treatment options for FL; however, no evidence was reported on MZL specifically. The significant data gaps in knowledge in these diseases demonstrate a marked need for further studies.

Cost-effectiveness of lenalidomide plus rituximab versus rituximab monotherapy in patients with previously treated follicular lymphoma: a societal view

“…Indeed, a recent systematic review in this area concluded a substantial need for further studies due to a significant evidence gap in this disease area [42]. This gap seems to be most prominent in previously treated FL patients, although this population appears to be particularly burdened by high health-care resource use and costs [42]. With our study we fill part of this gap, which could potentially be used as a reference point for future economic evaluations.…”

“…Rituximab is in use since a couple of decades for previously treated FL patients but thus far, no formal cost-effectiveness analysis has been performed. Indeed, a recent systematic review in this area concluded a substantial need for further studies due to a significant evidence gap in this disease area [42]. This gap seems to be most prominent in previously treated FL patients, although this population appears to be particularly burdened by high health-care resource use and costs [42].…”

Cost-effectiveness of obinutuzumab versus rituximab biosimilars for previously untreated follicular lymphoma

“…The ICER for G + chemo compared with Ra + chemo was $28,879 per QALY gained (95% CR = $14,524-$86,968), and the ICER for G + chemo compared with Rp + chemo was $23,082 per QALY gained (95% CR = $10,861-$76,500). 23,24 Our results from the model indicate that G + chemo continues to offer good economic value, including improved patient outcomes, compared with R + chemo or equivalents based on rituximab biosimilars, and that value-based policy decisions should consider G + chemo as standard of care for patients with untreated FL. Several factors drive the value of G + chemo in our economic model.…”

Estimating the Burden of Illness of Relapsed Follicular Lymphoma and Marginal Zone Lymphoma in Ontario, Canada

“…Furthermore, patients requiring subsequent lines of treatment were likely to be older and have more comorbid conditions than newly diagnosed patients. Disease progression was also a major driver of HCRU, cost and health-related quality of life following relapse after initial treatment and associated with substantial economic burden [23]. Beveridge et al, in a USA study, reported a four-fold increase in annual costs and medical visits of $30,890 for progression versus $8704 for non-progression [24].…”