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Cost-Effectiveness of Obinutuzumab in Combination with Bendamustine Followed by Obinutuzumab Maintenance versus Bendamustine Alone in Treatment of Patients with Rituximab-Refractory Follicular Lymphoma in Norway

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Abstract

Aims

To evaluate the cost-effectiveness of obinutuzumab in combination with bendamustine followed by obinituzumab maintenance (Obin-Benda) compared to bendamustine alone (Benda) in patients with refractory follicular lymphoma (FL) in a Norwegian setting.

Methods

A three-state area-under-the-curve (AUC) model was developed. The states included were progression-free-survival (PFS), progressed disease (PD), and death. Each state had costs and utilities assigned to it. The pivotal phase III randomized controlled trial GADOLIN was used for clinical input in the model along with Norwegian cost estimates. The trial demonstrated that Obin-Benda improved overall survival (OS), with a hazard ratio (HR) of 0.67 (95% CI 0.47–0.96), and reduced the likelihood of progression or death (HR 0.52, 95% CI 0.39–0.69) compared to Benda. The model used EQ-5D data collected in the GADOLIN trial, with UK tariffs assigned to the EQ-5D scores.

Results

The total quality adjusted life-years (QALYs) for the patients on Obin-Benda were estimated to be 4.67, compared to 3.65 for Benda, while the total costs were estimated to be €98,849 and €51,570, respectively. Obin-Benda had an incremental gain of 1.02 QALYs compared to Benda, at an additional cost of €47,279. The estimated deterministic incremental cost-effectiveness ratio (ICER) was €46,438 per QALY gained, while the probabilistic ICER was €46,887 per QALY gained (95% CI €34,772–€59,443). The results were robust to changes in various sensitivity and scenario analyses.

Conclusions

The cost-effectiveness threshold in Norway is not public, but based on previous decisions it is estimated to be up to approximately €89,000 per QALY (NOK 800,000). The results of the analysis indicate that obinutuzumab in combination with bendamustine followed by obinutuzumab maintenance may be cost-effective compared to bendamustine alone in Norway.

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Data Availability Statement

All the relevant model inputs have been provided in the manuscript and supplementary material. The cost-effectiveness model itself cannot be made publicly available because it could be used to calculate confidential prices in other countries. The model was provided to the reviewers under confidentiality.

Acknowledgements

Aino Launonen performed the statistical analyses for the clinical input data and reviewed the manuscript. Per-Olof Thuresson provided health economic support throughout the process.

Author information

Authors and Affiliations

  1. Roche Norge AS, Brynsengfaret 6 B, 0667, Oslo, Norway

    Fredrik Salvesen Haukaas & Audun Ohna

  2. Roche Products Limited, 6 Falcon Way, Shire Park, Welwyn Garden City Hertfordshire, UK

    Tania Krivasi

Authors
  1. Fredrik Salvesen Haukaas
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  3. Tania Krivasi
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Contributions

FSH decided on the input data, conducted the analyses, and wrote the draft manuscript. AO decided on the input data, provided assistance in conducting the analyses, and reviewed the manuscript. TK built the cost-effectiveness model and reviewed the manuscript.

Corresponding author

Correspondence to Fredrik Salvesen Haukaas.

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Declaration of funding

Both GADOLIN and the present study were funded by F. Hoffman-La Roche.

Declaration of financial/other relationships

Fredrik Salvesen Haukaas, Audun Ohna and Tania Krivasi are employees of F. Hoffmann-La Roche, which markets obinutuzumab (Gazyvaro®).

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Supplementary material 1 (DOCX 98 kb)

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Haukaas, F.S., Ohna, A. & Krivasi, T. Cost-Effectiveness of Obinutuzumab in Combination with Bendamustine Followed by Obinutuzumab Maintenance versus Bendamustine Alone in Treatment of Patients with Rituximab-Refractory Follicular Lymphoma in Norway. Appl Health Econ Health Policy 16, 569–577 (2018). https://doi.org/10.1007/s40258-018-0401-y

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