OBJECTIVES
Phase 3 randomized trials have shown that rituximab maintenance (MR) therapy or radio-immunotherapy (RIT) consolidation following frontline therapy can improve progression-free survival for patients with follicular lymphoma (FL), but the cost-effectiveness of these approaches with respect to observation has not been examined using a common modeling framework.
METHODS
We developed Markov models to estimate patients’ lifetime costs, quality-adjusted life years (QALYs), and life years (LYs) after MR, RIT, and observation following frontline FL treatment from the US payer’s perspective. Progression risks, adverse event probabilities, costs, and utilities were estimated from clinical data of PRIMA, ECOG trial (for MR) and FIT trial (for RIT), and the published literature. We evaluated the incremental cost-effectiveness ratio for direct comparisons between MR/RIT and observation. Model robustness was addressed by one-way and probabilistic sensitivity analyses.
RESULTS
Compared with observation, MR provided additional 1.089 QALYs (1.099 LYs) and 1.399 QALYs (1.391 LYs) based on PRIMA and ECOG trials respectively, and RIT provided additional 1.026 QALYs (1.034 LYs). The incremental cost per QALY-gained was $40,335 (PRIMA) or $37,412 (ECOG) for MR, and $40,851 for RIT. MR and RIT had comparable incremental QALYs before first progression, while RIT had higher incremental costs of adverse events due to higher incidences of cytopenias.
CONCLUSIONS
MR and RIT following frontline FL therapy demonstrated favorable and similar cost-effectiveness profiles. The model results should be interpreted within the specific clinical settings of each trial. Selection of MR, RIT, or observation should be based on patient characteristics and expected tradeoffs for these alternatives.