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

Author

Listed:
  • Eliazar Sabater

    (Pharmacoeconomics and Outcomes Research Iberia)

  • Armando López-Guillermo

    (Hospital Clinic)

  • Antonio Rueda

    (Hospital Costa del Sol)

  • Antonio Salar

    (Hospital del Mar)

  • Itziar Oyagüez

    (Pharmacoeconomics and Outcomes Research Iberia)

  • Juan Manuel Collar

    (Mundipharma Pharmaceuticals)

Abstract

Background Follicular lymphoma (FL) is the second most common type of lymphoid cancer in Western Europe. Objective The aim of this study was to evaluate the cost utility of rituximab–bendamustine treatment compared with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) treatment as a first-line therapy for patients with advanced FL in Spain. Methods A Markov model was developed to estimate the cost effectiveness of rituximab–bendamustine compared with R-CHOP as first-line treatment for patients with advanced FL in the Spanish National Health System (NHS). Transitions between health states (progression-free, including induction and maintenance; first relapse; second relapse; and death) were allowed for the patient cohort in 4-week-long cycles. Clinical data for the extrapolation of progression-free survival curves were obtained from randomized trials. Mortality rates and utilities were obtained from the literature. Outcomes were measured as quality-adjusted life-years (QALYs). The total costs (€, 2013) included drug costs (ex-factory prices with mandatory deductions), disease management costs and adverse event-associated costs. Costs and outcomes were discounted at a 3 % annual rate. Probabilistic sensitivity analysis was performed using 10,000 Monte Carlo simulations to assess the model robustness. Results Treatment and administration costs during the induction phase were higher for rituximab–bendamustine (€17,671) than for R-CHOP (€11,850). At the end of the 25-year period, the rituximab–bendamustine first-line strategy had a total cost of €68,357 compared with €69,528 for R-CHOP. Health benefits were higher for rituximab–bendamustine treatment (10.31 QALYs) than for R-CHOP treatment (9.82 QALYs). In the probabilistic analysis, rituximab–bendamustine was the dominant strategy over treatment with R-CHOP in 53.4 % of the simulations. Conclusion First-line therapy with rituximab–bendamustine in FL patients was the dominant strategy over treatment with R-CHOP; it showed cost savings and higher health benefits for the Spanish NHS.

Suggested Citation

  • Eliazar Sabater & Armando López-Guillermo & Antonio Rueda & Antonio Salar & Itziar Oyagüez & Juan Manuel Collar, 2016. "Cost-Effectiveness Analysis of Bendamustine Plus Rituximab as a First-Line Treatment for Patients with Follicular Lymphoma in Spain," Applied Health Economics and Health Policy, Springer, vol. 14(4), pages 465-477, August.
    • Handle: RePEc:spr:aphecp:v:14:y:2016:i:4:d:10.1007_s40258-016-0243-4
    DOI: 10.1007/s40258-016-0243-4
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    1. Julio López-Bastida & Juan Oliva & Fernando Antoñanzas & Anna García-Altés & Ramón Gisbert & Javier Mar & Jaume Puig-Junoy, 2010. "Spanish recommendations on economic evaluation of health technologies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(5), pages 513-520, October.
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