Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients: A population-based analysis

Sara Khor, Jaclyn Beca, Murray Krahn, David Hodgson, Linda Lee, Michael Crump, Karen E. Bremner, Jin Luo, Muhammad Mamdani, Chaim M. Bell, Carol Sawka, Scott Gavura, Terrence Sullivan, Maureen Trudeau, Stuart Peacock, Jeffrey S Hoch

Research output: Contribution to journalArticle

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Abstract

Background: Current treatment of diffuse-large-B-cell lymphoma (DLBCL) includes rituximab, an expensive drug, combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. Economic models have predicted rituximab plus CHOP (RCHOP) to be a cost-effective alternative to CHOP alone as first-line treatment of DLBCL, but it remains unclear what its real-world costs and cost-effectiveness are in routine clinical practice. Methods: We performed a population-based retrospective cohort study from 1997 to 2007, using linked administrative databases in Ontario, Canada, to evaluate the costs and cost-effectiveness of RCHOP compared to CHOP alone. A historical control cohort (n = 1,099) with DLBCL who received CHOP before rituximab approval was hard-matched on age and treatment intensity and then propensity-score matched on sex, comorbidity, and histology to 1,099 RCHOP patients. All costs and outcomes were adjusted for censoring using the inverse probability weighting method. The main outcome measure was incremental cost per life-year gained (LYG). Results: Rituximab was associated with a life expectancy increase of 3.2 months over 5 years at an additional cost of $16,298, corresponding to an incremental cost-effectiveness ratio of $61,984 (95% CI $34,087-$135,890) per LYG. The probability of being cost-effective was 90% if the willingness-to-pay threshold was $100,000/LYG. The cost-effectiveness ratio was most favourable for patients less than 60 years old ($31,800/LYG) but increased to $80,600/LYG for patients 60-79 years old and $110,100/LYG for patients ≥ 80 years old. We found that post-market survival benefits of rituximab are similar to or lower than those reported in clinical trials, while the costs, incremental costs and cost-effectiveness ratios are higher than in published economic models and differ by age. Conclusions: Our results showed that the addition of rituximab to standard CHOP chemotherapy was associated with improvement in survival but at a higher cost, and was potentially cost-effective by standard thresholds for patients <60 years old. However, cost-effectiveness decreased significantly with age, suggesting that rituximab may be not as economically attractive in the very elderly on average. This has important clinical implications regarding age-related use and funding decisions on this drug.

Original languageEnglish (US)
Article number586
JournalBMC Cancer
Volume14
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

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Lymphoma, Large B-Cell, Diffuse
Cost-Benefit Analysis
Costs and Cost Analysis
Population
Economic Models
Rituximab
Drug Therapy
Propensity Score
Survival
Vincristine
Ontario
Prednisone
Life Expectancy
Pharmaceutical Preparations
Doxorubicin
Cyclophosphamide
Canada
Comorbidity
Histology
Cohort Studies

ASJC Scopus subject areas

  • Oncology
  • Genetics
  • Cancer Research

Cite this

Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients : A population-based analysis. / Khor, Sara; Beca, Jaclyn; Krahn, Murray; Hodgson, David; Lee, Linda; Crump, Michael; Bremner, Karen E.; Luo, Jin; Mamdani, Muhammad; Bell, Chaim M.; Sawka, Carol; Gavura, Scott; Sullivan, Terrence; Trudeau, Maureen; Peacock, Stuart; Hoch, Jeffrey S.

In: BMC Cancer, Vol. 14, No. 1, 586, 2014.

Research output: Contribution to journalArticle

Khor, S, Beca, J, Krahn, M, Hodgson, D, Lee, L, Crump, M, Bremner, KE, Luo, J, Mamdani, M, Bell, CM, Sawka, C, Gavura, S, Sullivan, T, Trudeau, M, Peacock, S & Hoch, JS 2014, 'Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients: A population-based analysis', BMC Cancer, vol. 14, no. 1, 586. https://doi.org/10.1186/1471-2407-14-586
Khor, Sara ; Beca, Jaclyn ; Krahn, Murray ; Hodgson, David ; Lee, Linda ; Crump, Michael ; Bremner, Karen E. ; Luo, Jin ; Mamdani, Muhammad ; Bell, Chaim M. ; Sawka, Carol ; Gavura, Scott ; Sullivan, Terrence ; Trudeau, Maureen ; Peacock, Stuart ; Hoch, Jeffrey S. / Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients : A population-based analysis. In: BMC Cancer. 2014 ; Vol. 14, No. 1.
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T1 - Real world costs and cost-effectiveness of Rituximab for diffuse large B-cell lymphoma patients

T2 - A population-based analysis

AU - Khor, Sara

AU - Beca, Jaclyn

AU - Krahn, Murray

AU - Hodgson, David

AU - Lee, Linda

AU - Crump, Michael

AU - Bremner, Karen E.

AU - Luo, Jin

AU - Mamdani, Muhammad

AU - Bell, Chaim M.

AU - Sawka, Carol

AU - Gavura, Scott

AU - Sullivan, Terrence

AU - Trudeau, Maureen

AU - Peacock, Stuart

AU - Hoch, Jeffrey S

PY - 2014

Y1 - 2014

N2 - Background: Current treatment of diffuse-large-B-cell lymphoma (DLBCL) includes rituximab, an expensive drug, combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy. Economic models have predicted rituximab plus CHOP (RCHOP) to be a cost-effective alternative to CHOP alone as first-line treatment of DLBCL, but it remains unclear what its real-world costs and cost-effectiveness are in routine clinical practice. Methods: We performed a population-based retrospective cohort study from 1997 to 2007, using linked administrative databases in Ontario, Canada, to evaluate the costs and cost-effectiveness of RCHOP compared to CHOP alone. A historical control cohort (n = 1,099) with DLBCL who received CHOP before rituximab approval was hard-matched on age and treatment intensity and then propensity-score matched on sex, comorbidity, and histology to 1,099 RCHOP patients. All costs and outcomes were adjusted for censoring using the inverse probability weighting method. The main outcome measure was incremental cost per life-year gained (LYG). Results: Rituximab was associated with a life expectancy increase of 3.2 months over 5 years at an additional cost of $16,298, corresponding to an incremental cost-effectiveness ratio of $61,984 (95% CI $34,087-$135,890) per LYG. The probability of being cost-effective was 90% if the willingness-to-pay threshold was $100,000/LYG. The cost-effectiveness ratio was most favourable for patients less than 60 years old ($31,800/LYG) but increased to $80,600/LYG for patients 60-79 years old and $110,100/LYG for patients ≥ 80 years old. We found that post-market survival benefits of rituximab are similar to or lower than those reported in clinical trials, while the costs, incremental costs and cost-effectiveness ratios are higher than in published economic models and differ by age. Conclusions: Our results showed that the addition of rituximab to standard CHOP chemotherapy was associated with improvement in survival but at a higher cost, and was potentially cost-effective by standard thresholds for patients <60 years old. However, cost-effectiveness decreased significantly with age, suggesting that rituximab may be not as economically attractive in the very elderly on average. This has important clinical implications regarding age-related use and funding decisions on this drug.

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