PharmacoEconomics

, Volume 27, Issue 1, pp 55–68

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

  • Philippe Fagnoni
  • Noel Milpied
  • Samuel Limat
  • Eric Deconinck
  • Virginie Nerich
  • Charles Foussard
  • Philippe Colombat
  • Jean-Luc Harousseau
  • Marie-Christine Woronoff-Lemsi
Original Research Article

DOI: 10.2165/00019053-200927010-00006

Cite this article as:
Fagnoni, P., Milpied, N., Limat, S. et al. Pharmacoeconomics (2009) 27: 55. doi:10.2165/00019053-200927010-00006

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.

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Philippe Fagnoni
    • 1
    • 2
  • Noel Milpied
    • 3
  • Samuel Limat
    • 1
    • 2
  • Eric Deconinck
    • 4
    • 5
  • Virginie Nerich
    • 1
    • 4
  • Charles Foussard
    • 6
  • Philippe Colombat
    • 7
  • Jean-Luc Harousseau
    • 8
  • Marie-Christine Woronoff-Lemsi
    • 1
    • 4
  1. 1.Department of PharmacyUniversity Hospital of BesançonBesançon CedexFrance
  2. 2.INSERM, EPI 106University of BourgogneDijonFrance
  3. 3.Department of HaematologyUniversity Hospital of BordeauxPessacFrance
  4. 4.INSERM, U 645 EA-2284 IFR-133University Franche-ComteBesançonFrance
  5. 5.Department of HaematologyUniversity Hospital of BesançonBesançonFrance
  6. 6.Department of HaematologyUniversity Hospital of AngersAngersFrance
  7. 7.Department of HaematologyUniversity Hospital of ToursToursFrance
  8. 8.Department of HaematologyUniversity Hospital of NantesNantesFrance

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