Cost-effectiveness analysis of bendamustine plus rituximab versus CHOP-R in treatment-naive patients with mantle cell (MCL) and indolent lymphomas (IL).

Abstract

6553 Background: To assess the cost-effectiveness of bendamustine plus rituximab (B-R) vs cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (CHOP‑R) for treatment-naive patients with MCL or IL from a US healthcare payer perspective. Methods: A discrete event simulation was developed for a mixed population of patients with MCL or IL. Two arms were simulated, each containing 1000 identical MCL or IL patients treated with B-R or CHOP-R. Input data for baseline characteristics, overall response, and risks for treatment-related adverse events (AEs) and infections were obtained from the NHL 1-2003 trial (n=549, primarily stage IV MCL and IL); gaps were filled by consultation with experts. Direct medical costs and utilities were estimated based on US databases and published literature. Costs and benefits were discounted at 3% per annum. Base case model predictions were performed by selecting regression models that had a best fit to progression free survival (PFS). Robustness of these models was evaluated by testing other models with reasonably good fit. Results: In the base case, model predicts longer PFS for B-R than for CHOP-R in MCL (average of 49.8 vs 28.6 months) and IL (67.9 vs 51.0). Quality-adjusted life-years (QALYs) per patient were higher for B-R than CHOP-R for MCL (3.51 vs 2.68) and IL (4.42 vs 3.58). For MCL, total per-patient costs were $115,191 for B-R and $100,261 for CHOP-R; for IL, respective costs were $134,814 and $110,065, resulting in incremental cost-effectiveness ratios (ICERs) for B-R vs CHOP-R of $18,161 per QALY for MCL and $29,549 for IL (ICER<$50,000 to be cost-effective). Higher complete and partial response rates for B-R than for CHOP-R impacted subsequent treatment costs, which were lower for B-R by $21,632 for MCL and $24,961 for IL, as well as AE costs, lower by $10,113 and $10,570, respectively. The model results were robust with respect to the use of alternative regression models for PFS estimation. Conclusions: In patients with MCL or IL, the model demonstrates that B-R is a cost-effective alternative to CHOP-R. Alternative regression models confirmed robustness of results. Support: Teva Pharmaceutical Industries Ltd.

Outcomes of patients with indolent lymphoma treated with bendamustine plus rituximab compared to rituximab plus CVP or CHOP chemoimmunotherapy in Ontario

“…One cost-effectiveness Markov model analysis by Sabater et al found higher treatment and administrative costs with the use of BR compared to R-CHOP during induction, but overall cost savings with BR at 25 years, owing to better disease control. 22 Similar findings have been described by other groups, 23,24 suggesting BR is an overall costeffective regimen.…”

Cost-Effectiveness Analysis of Bendamustine Plus Rituximab as a First-Line Treatment for Patients with Follicular Lymphoma in Spain

“…This study is the first evaluation focused on FL which assessed lifetime efficiency of R-B first-line strategy considering a rituximab maintenance for 2 years, as well as up to 2 potential relapses. Taking into account management of relapses rises as the key driver that explains the higher total costs in comparison of other economical evaluation [20,28,29] , and the long-term savings associated with R-B arm.…”