Costs of Chemotherapy for Indolent Follicular Non-Hodgkin’s Lymphoma in the UK: An Observational Study

Hutchinson, Julia; Lloyd, Adam; Gray, Alastair; Gale, Rupert; Hancock, Barry W.

doi:10.1159/000089462

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…[5,10,12,17,18,25] Cost analyses compare it with other commonly used therapies, notably fludarabine, with which its overall costs appear equivalent. [2,4,8,9] An estimate of its overall costs to the UK suggests that these costs are fairly low. [5] Despite all of this attention to rituximab, many newer and novel therapies still have not been subjected to economic evaluations; nor have relatively simple and inexpensive (often first-line) therapies for low-grade lymphomas, such as radiotherapy, chlorambucil with or without prednisone, or even watchful waiting.…”

Section: Discussionmentioning

confidence: 99%

“…Nearly two-thirds had not yet been treated 6 years later. This study recorded the reasons the 43 patients had not been given initial therapy: physician choice (20 patients), need for radiation to cover a large abdominal field (10), advanced age (7), concerns about mouth dryness (4) or patient refusal of therapy (2). [50] While watchful waiting avoids the potential for treatment-related adverse effects, patients often feel nervous during this period about receiving no therapy for their cancer.…”

Section: Rituximab Maintenancementioning

confidence: 99%

“…[4,8,9] However, oral formulations of fludarabine have become available and in the UK were calculated to be less expensive than intravenous fludarabine. [2] United Kingdom…”

Section: Direct Costsmentioning

confidence: 99%

“…Estimates of the direct, per-patient costs of FNHL treatment to the UK NHS are available from a recently published study by Hutchinson et al [2] This retrospective study analysed approximately 3 years of resource-use data from treatment administered in usual practice to 181 patients at all disease stages and lines of treatment, including chlorambucil, CHOP, CVP or fludarabine (monotherapy and combination therapy), rituximab, and other monotherapies and combination therapies. Resource components were grouped into multiple categories, including chemotherapy drugs and their administration (both inpatient and outpatient), physician costs for chemotherapy drug administration (on ward, in clinics, other outpatient visits), adverse events, tests and diagnostics, and other drugs related to FNHL treatment (e.g.…”

Section: Direct Costsmentioning

confidence: 99%

“…The average costs of CHOP and intravenous fludarabine (mono and combination) were estimated at d3038 ($US5093) and d6132 ($US10 281), respectively. [2] It is important to point out that Hutchinson et al [2] acknowledge that an oral formulation of fludarabine became available subsequent to the data collection period covered by the study. Because the introduction of oral fludarabine has important cost implications, the authors recalculated the cost of fludarabine by assuming that only a single outpatient visit per chemotherapy cycle would be required for its administration.…”

Section: Direct Costsmentioning

confidence: 99%

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Economic Burden of Follicular Non-Hodgkinʼs Lymphoma

Foster¹,

Miller²,

Boye

et al. 2009

PharmacoEconomics

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Follicular non-Hodgkin's lymphoma (FNHL), a slow-growing cancer of the immune system, constitutes about 15-30% of all incident non-Hodgkin's lymphoma in developed countries. Its incidence is rising worldwide. Patients can live many years, but FNHL is considered incurable. We systematically reviewed the English-language MEDLINE-indexed and non-indexed economic literature published in the past 10 years on FNHL, identifying 23 primary economic studies. The economic burden of FNHL is significant, but available data are generally limited to retrospective considerations of hospital-based direct treatment costs, with little information available regarding societal cost of illness. Most direct cost information originates from the US, with one estimate of $US36 000 for the per-patient incremental cost of FNHL care during the first year following diagnosis. The most studied treatment is rituximab, which may offer similar overall costs to fludarabine considering higher resource use with fludarabine complications. Nearly all cost-effectiveness models identified by this review evaluated rituximab for relapsed/refractory FNHL responding to chemotherapy induction. Rituximab is supported as a cost-effective addition to standard chemotherapy by two models in the UK and one in the US, as maintenance therapy instead of stem-cell transplant by one UK model, and as maintenance therapy instead of observation alone by one model each in France, Spain and Canada. The UK National Institute for Health and Clinical Excellence updated guidance on rituximab in February 2008, concluding that it is cost effective when added to induction chemotherapy, and when used as maintenance therapy. No studies of per-patient or national indirect costs of illness were identified, with the only study of indirect costs a Canadian survey documenting lost work productivity. Across all study types identified by our review, the most common focus was on the direct costs of rituximab. As new treatments for FNHL come to market, more real-life cost data are imperative to calculate their relative cost effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Rituximab Maintenancementioning

confidence: 99%

“…[4,8,9] However, oral formulations of fludarabine have become available and in the UK were calculated to be less expensive than intravenous fludarabine. [2] United Kingdom…”

Section: Direct Costsmentioning

confidence: 99%

Section: Direct Costsmentioning

confidence: 99%

Section: Direct Costsmentioning

confidence: 99%

See 3 more Smart Citations

Economic Burden of Follicular Non-Hodgkinʼs Lymphoma

Foster¹,

Miller²,

Boye

et al. 2009

PharmacoEconomics

View full text Add to dashboard Cite

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Current Awareness in Hematological Oncology

2006

Hematological Oncology

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of hematological oncology. Each bibliography is divided into 14 sections: 1 Books, Reviews & Symposia; 2 General; Leukemias: 3 Lymphoblastic; 4 Myeloid & Myelodysplastic Syndromes; 5 Chronic; 6 Others; Lymphomas: 7 Hodgkin's; 8 Non‐Hodgkin's; 9 Plasmacytomas/Multiple Myelomas; 10 Others; 11 Bone Marrow Transplantation; 12 Cytokines; 13 Diagnosis; 14 Cytogenetics. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.

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Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin's lymphoma

Boland

Bagust

Hockenhull

et al. 2009

Health Technol Assess

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This paper presents a summary of the evidence review group report into the clinical effectiveness and cost-effectiveness of rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin's lymphoma (NHL), in accordance with the licensed indication, based upon the evidence submission from Roche Products Ltd to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submitted clinical evidence included two randomised controlled trials [European Organisation for Research and Treatment of Cancer (EORTC) and German Low Grade Lymphoma Study GroupFludarabine, Cyclophosphamide and Mitoxantrone and (GLSG-FCM)] comparing the clinical effects of chemotherapy with or without rituximab in the induction of remission at first or second relapse and the clinical benefits of rituximab maintenance therapy versus the NHS's current clinical practice of observation for follicular lymphoma (FL) patients. Both trials showed that in patients with relapsed FL the addition of rituximab to chemotherapy induction treatment increased overall response rates. Furthermore, rituximab maintenance therapy increased the median length of remission when compared with observation only. Safety data from the two trials showed that while the majority of patients reported some adverse events, the number of patients withdrawing from treatment in the EORTC trial was low, with rates not being reported for the GLSG-FCM trial. Discussion of ERG reports is invited. Visit the HTA website correspondence forum (www.hta.ac.uk/ correspond). DOI: 10.3310/hta13suppl2/06 Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin's lymphoma 42The most commonly reported adverse events were blood/bone marrow toxicity, skin rashes and allergies. The ERG reran the manufacturer's economic model after altering several of the assumptions and parameter values in order to recalculate the cost-utility ratios, quality-adjusted life-years (QALYs) and estimates of benefits. The manufacturer reported that maintenance therapy with rituximab was cost-effective compared with observation against commonly applied thresholds, with an incremental cost-effectiveness ratio of £7721 per QALY gained. The greatest clinical effectiveness is achieved by R-CHOP followed by rituximab maintenance (R-CHOP>R) and this treatment strategy had the greatest probability of being cost-effective for a QALY of approximately £18,000 or greater. The guidance issued by NICE as a result of the STA states that in people with relapsed stage III or IV follicular NHL, rituximab is now an option in combination with chemotherapy to induce remission or alone as maintenance therapy during remission. Rituximab monotherapy is also an option for people with relapsed or refractory disease when all alternative treatment options have been exhausted.

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Costs of Chemotherapy for Indolent Follicular Non-Hodgkin’s Lymphoma in the UK: An Observational Study

Cited by 3 publications

References 12 publications

Economic Burden of Follicular Non-Hodgkinʼs Lymphoma

Economic Burden of Follicular Non-Hodgkinʼs Lymphoma

Current Awareness in Hematological Oncology

Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin's lymphoma

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