Summary
Diffuse large-B-cell lymphoma (DLBCL) is an aggressive form of lymphoma. Before the development of monoclonal antibodies, standard treatment of DLBCL was based on polychemotherapy regimens of first (CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisone), second and third generation (ProMACE-CytaBOM, cyclophosphamide, doxorubicin, etoposide, cytosine arabinoside, bleomycin, vincristine, methotrexate, and prednisone). Current treatment consists of the combination of CHOP and the monoclonal antibody rituximab (R-CHOP regimen).
The aim of this study was to compare the efficacy (life-years gained [LYG]) and mean costs (direct medical costs) over a period of 3 years of two chemotherapy regimens, R-CHOP and ProMACE-CytaBOM (Pro-Cy), in the treatment of DLBCL from the Health Service of Regione Emilia Romagna perspective.
A decision-analysis model with tree structure was used to compare R-CHOP and Pro-Cy in the treatment of DLBCL. Twenty-six patients with DLBCL diagnosis entered at the root of the tree and followed one of the six possible therapeutic pathways. After receiving one of the two chemotherapy treatments (R-CHOP or Pro-Cy) patients could have a complete response or not. In the case of relapse (progression free survival, PFS), patients were given rescue therapy. Data included the Diagnosis Related Groups (DRGs), regional inpatient tariffs and the Italian market price for drugs (year 2009).
The LYG with the R-CHOP regimen was higher (2.58 LYG per patient) than with the Pro-Cy regimen (1.43 LYG per patient). When taking into account the cost of rescue therapy, the overall mean treatment cost per patient was lower with the R-CHOP regimen (€18,768.96) than with the Pro-Cy regimen (€28,091.22). Univariate and threshold sensitivity analyses confirmed robustness of results.
On the basis of these findings, R-CHOP was confirmed as the dominant therapy (lower expected mean costs, higher number of LYG) for survival at 3 years.
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Merli, F., Ravasio, R., Alvarez De Cielis, I. et al. Analisi di costo-efficacia di rituximab più CHOP versus ProMACE-CytaBOM nel trattamento del linfoma diffuso a grandi cellule B: l’esperienza di Reggio Emilia. G. Ital. Health Technol. Assess 2, 55–64 (2009). https://doi.org/10.1007/BF03320719
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DOI: https://doi.org/10.1007/BF03320719