Fludarabine: A Phase II Trial in Patients with Previously Treated Low-Grade Lymphoma

Falkson, Carla I.

doi:10.1097/00000421-199606000-00012

Cited by 20 publications

(6 citation statements)

References 5 publications

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“…The absence of a standardized approach to the treatment of relapsed low-grade NHL was evident in the telephone survey stage of this analysis and is supported by another recent study [23]. The similarity of response rates with the regimens investigated here has been well documented [23,29,30,31,32] and may well be one of the main reasons for the absence of a standard approach.As a result, particular emphasis is placed on tolerability and cost-effectiveness by clinicians when deciding which treatment regimens to use. Therefore economic studies such as this one may well provide valuable information for the future management of patients with low-grade NHL.…”

Section: Discussionsupporting

confidence: 62%

Costs of toxicity during chemotherapy with CHOP, COP/CVP, and fludarabine

Herold

Hieke²

2002

Eur J Health Econom

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The costs of chemotherapy toxicity were analyzed in patients with relapsed low-grade non-Hodgkin's lymphoma (NHL). A total of 91 specialists regularly treating NHL were interviewed by telephone to identify the most commonly used treatment regimens. Retrospective case record forms providing data on 424 patients with relapsed low-grade NHL were used to assess adverse event (AE) frequency and management. Data on one cycle of treatment was collected for each patient, and unit costs were assessed and extrapolated for six cycles to estimate AE costs for an average course of treatment. Average AE management costs were evaluated by country and treatment regimen. Toxicity costs were substantial for the most commonly used chemotherapy regimens, namely CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), COP/CVP (cyclophosphamide, vincristine, prednisone), and fludarabine therapies. In Canada CHOP-associated AEs costs (EUR 5.036 per patient) were more than twofold greater than drug acquisition costs, and cost more than AEs associated with COP/CVP (EUR 3.252) or fludarabine (EUR 1.273). In Germany CHOP-associated AE costs (EUR 2.515) were comparable to to those associated with COP/CVP (EUR 2.658). In Italy CHOP-associated AE costs (EUR 2.179) were considerably less than those associated with fludarabine treatment (EUR 4.908). Neutropenia and fever/infection AEs were the most common and more expensive to treat than nausea and vomiting, anaemia, thrombocytopenia, or other AEs in all three countries. This study shows that management of neutropenia and fever/infection are the most expensive AE costs associated with conventional chemotherapeutic treatment of relapsed low-grade NHL. AE management costs are substantial and are likely to be an important cost driver in all countries.

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Section: Discussionsupporting

confidence: 62%

Costs of toxicity during chemotherapy with CHOP, COP/CVP, and fludarabine

Herold

Hieke²

2002

Eur J Health Econom

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“…The number and variety of regimens employed may well reflect similarities in response rates and remission times among the available therapies and emphasizes the need for new treatment strategies [31]. Indeed, the similarity of response with the regimens investigated here has been well documented [19,32–35] and, in the absence of new treatment strategies, particular emphasis will be placed on tolerability and cost‐effectiveness by clinicians when deciding which treatment regimens to use. Therefore, economic studies such as this one may well provide valuable information for the future management of patients with low‐grade NHL.…”

Section: Discussionmentioning

confidence: 90%

Costs of Drug Delivery for CHOP, COP/CVP, and Fludarabine: An International Assessment

Herold¹,

Hieke²

2003

Value in Health

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Costs of drug administration are a major driver for total direct treatment costs in the treatment of relapsed low-grade NHL and are at least as important as drug acquisition costs. Drug administration practices, in terms of inpatient or outpatient treatment, are a major factor in determining overall direct costs. Therapeutic strategies, which offer shortened treatment duration and/or a simple mode of administration, are likely to be economically attractive.

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“…The use of fludarabine for relapsed low‐grade NHL has been reported in several studies. The overall response rate ranged from 44% to 69% (Whelan et al , 1991; Falkson et al , 1996) (Table VI).…”

Section: Discussionmentioning

confidence: 99%

“…Together with the new monoclonal antibody rituximab, these treatments were chosen for the economic analysis. Although no prospective trials have been conducted, the available literature suggests there is not a significant difference between CHOP, fludarabine and rituximab in terms of response rates and response duration (Falkson, 1996; Foran et al , 1998a, b; Hochster et al , 1992; Kimby et al , 1994; Maloney et al , 1997; McLaughlin et al , 1998; Pigaditou et al , 1993; Solal‐Celigny et al , 1996; Whelan et al , 1991; Zinzani et al , 1993). However, there are apparent differences in the incidence and severity of drug‐related adverse events, which may impact on the economic implications of each regimen.…”

Section: Methodsmentioning

confidence: 99%

Cost‐minimization analysis of CHOP, fludarabine and rituximab for the treatment of relapsed indolent B‐cell non‐Hodgkin's lymphoma in the U.K.

et al. 1999

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Summary. The optimal therapy for patients with relapsed indolent B-cell non-Hodgkin's lymphoma is unclear. Combination chemotherapy such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) or purine analogues including¯udarabine are frequently used and the anti-CD20 monoclonal antibody rituximab has recently been licensed for use. However, no comparative studies of these therapies have been reported. Since relapsed indolent B-cell NHL is generally regarded as incurable with current therapies, the place of each of these therapies is likely to be determined by their relative ef®cacy, toxicity and cost. We undertook a literature review and a retrospective analysis of patients receiving combination chemotherapy for relapsed indolent B-cell NHL at our institution to determine the response rates and the duration of response when treated with CHOP or udarabine. Reported response rates and median response duration for these regimens are similar, and similar to those reported in phase II studies of rituximab. A cost minimization analysis was therefore conducted.The per patient costs for the treatment of drug-related adverse events were £5049 for CHOP, £2953 for¯udarabine and £109 for rituximab. When costs of a full course of each treatment were compared, the costs per patient for CHOP, udarabine and rituximab were £7210 (£5975±8445), £10022 (£8917±11126) and £6080 (£5892±6267) respectively. In this preliminary analysis, rituximab appeared to have a similar ef®cacy rate to CHOP and¯udarabine, but had signi®cantly fewer adverse events and a lower total cost per patient. These data require con®rmation in a prospective randomized study with formal assessment of costeffectiveness.

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Fludarabine: A Phase II Trial in Patients with Previously Treated Low-Grade Lymphoma

Cited by 20 publications

References 5 publications

Costs of toxicity during chemotherapy with CHOP, COP/CVP, and fludarabine

Costs of toxicity during chemotherapy with CHOP, COP/CVP, and fludarabine

Costs of Drug Delivery for CHOP, COP/CVP, and Fludarabine: An International Assessment

Cost‐minimization analysis of CHOP, fludarabine and rituximab for the treatment of relapsed indolent B‐cell non‐Hodgkin's lymphoma in the U.K.

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