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Cost Effectiveness of High-Dose Chemotherapy with Autologous Stem Cell Support as Initial Treatment of Aggressive Non-Hodgkin’s Lymphoma

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Abstract

Background: The GOELAMS 072 study showed that first-line high-dose chemotherapy (HDT) with peripheral blood stem cell transplant (PBSCT) support was superior to the standard chemotherapy regimen (cyclophosphamide, doxorubicin, vincristine and prednisone; CHOP) in adults with aggressive non-Hodgkin’s lymphoma (NHL).

Objective: The aim of the study was to evaluate the pharmacoeconomic profile of HDT with PBSCT support relative to standard CHOP therapy as first-line treatment in adults with aggressive NHL.

Methods: We performed a cost-effectiveness analysis from the French Public Health Insurance perspective, restricted to hospital costs (€, year 2008 values). The clinical effectiveness criterion was censured overall survival (OS) difference after a median follow-up of 4 years for the entire cohort. A total of 197 patients were included (CHOP, n = 99; HDT, n = 98). Uncertainty was assessed using non-parametric bootstrap simulations and various scenario analyses.

Results: Five-year OS did not differ significantly between groups for the entire cohort. Nevertheless, subgroup analyses appeared to be more relevant for decision making: among patients with a high-intermediate risk according to the age-adjusted International Prognostic Index (IPI), HDT yielded a significantly higher 5-year OS than CHOP (74% vs 44%; p = 0.001). Among these patients, the mean censured OS survival, adjusted for time discounting and quality of life (QOL), increased with HDT by 1.20 years (95% CI 1.19, 1.21). The cost per life-year saved with HDT was estimated as h34 315 (95% CI 32 683, 35 947) in this subgroup.

Conclusion: Results suggested thatHDT with PBSCT supportmight be considered a cost-effective strategy among patients with high-intermediate-risk NHL according to the age-adjusted IPI. Its place and its cost effectiveness potential versus, or in combination with, rituximab still need further research.

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Acknowledgements

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

The authors would like to thank Michel Lamure, Céline Menat, Fanny Gaillard, Vincent Delwail, Christian Berthou, Rémy Gressin, Jean-Yves Cahn and Virginie Lucas.

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Authors and Affiliations

  1. Department of Pharmacy, University Hospital of Besançon, Boulevard Fleming, 25030, Besançon Cedex, France

    Philippe Fagnoni, Samuel Limat, Virginie Nerich &  Marie-Christine Woronoff-Lemsi

  2. INSERM, EPI 106, University of Bourgogne, Dijon, France

    Philippe Fagnoni & Samuel Limat

  3. Department of Haematology, University Hospital of Bordeaux, Pessac, France

    Noel Milpied

  4. INSERM, U 645 EA-2284 IFR-133, University Franche-Comte, Besançon, France

    Eric Deconinck, Virginie Nerich &  Marie-Christine Woronoff-Lemsi

  5. Department of Haematology, University Hospital of Besançon, Besançon, France

    Eric Deconinck

  6. Department of Haematology, University Hospital of Angers, Angers, France

    Charles Foussard

  7. Department of Haematology, University Hospital of Tours, Tours, France

    Philippe Colombat

  8. Department of Haematology, University Hospital of Nantes, Nantes, France

    Jean-Luc Harousseau

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  1. Philippe Fagnoni
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Correspondence to Marie-Christine Woronoff-Lemsi.

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Fagnoni, P., Milpied, N., Limat, S. et al. Cost Effectiveness of High-Dose Chemotherapy with Autologous Stem Cell Support as Initial Treatment of Aggressive Non-Hodgkin’s Lymphoma. Pharmacoeconomics 27, 55–68 (2009). https://doi.org/10.2165/00019053-200927010-00006

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