Cost‐effectiveness of rituximab as maintenance treatment for relapsed follicular lymphoma: results of a population‐based study

Blommestein, Hedwig M.; Issa, Djamila E.; Pompen, Marjolein; Hoor, G ten; Hogendoorn, Mels; Joosten, Peter; Huijgens, Peter C.; Groot, Carin A. Uyl–de

doi:10.1111/ejh.12264

Cited by 17 publications

(27 citation statements)

References 19 publications

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“…The influence of MR on the rate of histological transformation remains unclear because information on histological transformation was not routinely collected during follow‐up for E1496. Although there is controversy about improvements in the quality of life with MR, some studies suggest an economic benefit …”

Section: Discussionmentioning

confidence: 99%

Randomized phase 3 study in low‐grade lymphoma comparing maintenance anti‐CD20 antibody with observation after induction therapy: A trial of the ECOG‐ACRIN Cancer Research Group (E1496)

Barta

Hochster

et al. 2016

Cancer

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Background In the ECOG-ACRIN Cancer Research Group study, E1496, we reported that maintenance rituximab prolonged progression-free survival when compared to observation alone in patients with indolent lymphoma after induction chemotherapy. Here we present the long-term follow-up of the same patient cohort. Methods Patients with indolent lymphoma received induction chemotherapy with cyclophosphamide, vincristine, and prednisone (CVP). Patients with stable disease or better were then randomized to weekly rituximab (375mg/m2) ×4 every 6 months for 2 years (MR) or observation (OBS). The primary endpoint was progression-free survival (PFS); secondary endpoints were overall survival (OS), response rate and toxicities. Results Of 387 patients who initially received CVP induction, 158 were randomized to MR and 153 to OBS. After a median follow-up of 11.5 years, patients on MR had a longer median PFS (4.8 years) than patients on OBS (1.3 years; hazard ratio (HR) 0.49; p<0.0001). However, there was no difference in OS between MR and OBS (10-year OS 67% vs. 59%; median OS: 13.5 years vs. not reached; HR 0.91; p=0.69). Only minimal residual disease after induction therapy was significantly associated with PFS on multivariate analysis (HR 0.71; p=0.02). Low initial tumor burden, minimal residual disease, follicular histology, high FLIPI score, and male gender, were associated with OS. There was no difference in the rate of second primary malignancies between MR and OBS. Conclusions With long term follow up, MR did not influence the OS. The PFS benefit was maintained. MR should be considered optional in patients with indolent B-cell lymphoma.

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Section: Discussionmentioning

confidence: 99%

Randomized phase 3 study in low‐grade lymphoma comparing maintenance anti‐CD20 antibody with observation after induction therapy: A trial of the ECOG‐ACRIN Cancer Research Group (E1496)

Barta

Hochster

et al. 2016

Cancer

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“…For example, the ICERs were $20,000–30,000 per QALY gained for first-line R-chemotherapy regimens compared with chemotherapy alone (30, 45, 46), for first-line bendamustine with rituximab compared with R-chemotherapy (47), and for MR compared with observation for relapsed FL (32, 48). Despite differences in model settings, costs, and health systems between countries, these studies revealed a similar magnitude of ICERs for these treatment strategies for indolent lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Cost-Effectiveness of Rituximab Maintenance and Radioimmunotherapy Consolidation versus Observation Following First-Line Therapy in Patients with Follicular Lymphoma

et al. 2015

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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.

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“…With regard to willingness-to-pay value in Sweden of up to 54,000 € per intervention, rituximab maintenance in relapsed setting was cost-eff ective. Recently, a Dutch population-based study used registry data comprising 3581 patients with relapsed FL undergoing maintenance therapy 57 . Th e incremental cost-eff ectiveness ratio (ICER) was 11,254 € per QALY and 10,591 € per LYG.…”

Section: Th E Cost-eff Ectiveness Of Rituximab Maintenancementioning

confidence: 99%

Rituximab Maintenance Strategy in Advanced Follicular Lymphoma: Facts and Controversies

Milunović

Patekar

Jakubac

et al. 2017

acc

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SUMMARY -Rituximab is a chimeric monoclonal CD20 antibody used in the treatment of CD20 positive non-Hodgkin lymphomas and has revolutionized treatment approach to these hematologic malignancies in the last decade. Th e main aim of this review is to present data on the use of rituximab in the treatment of follicular lymphoma (FL). We will focus on rituximab maintenance strategies in the fi rst and second line treatment. Th is approach has improved the outcome in FL patients with better progression-free survival in all patients and better overall survival in relapsed setting. Regardless of good results, this strategy has generated controversies in medical community in the range from the lack of overall survival benefi t in fi rst line setting, adverse eff ects of possible overtreatment and toxicities to its unknown role in the era of novel agents. Th e existing data suggest that rituximab maintenance should be a rational therapeutic option for all patients with FL responding to fi rst line therapy and transplant-ineligible patients responding to reinduction.

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Cost‐effectiveness of rituximab as maintenance treatment for relapsed follicular lymphoma: results of a population‐based study

Cited by 17 publications

References 19 publications

Randomized phase 3 study in low‐grade lymphoma comparing maintenance anti‐CD20 antibody with observation after induction therapy: A trial of the ECOG‐ACRIN Cancer Research Group (E1496)

Randomized phase 3 study in low‐grade lymphoma comparing maintenance anti‐CD20 antibody with observation after induction therapy: A trial of the ECOG‐ACRIN Cancer Research Group (E1496)

Comparing the Cost-Effectiveness of Rituximab Maintenance and Radioimmunotherapy Consolidation versus Observation Following First-Line Therapy in Patients with Follicular Lymphoma

Rituximab Maintenance Strategy in Advanced Follicular Lymphoma: Facts and Controversies

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