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Cost Effectiveness of Rituximab Maintenance Therapy in Follicular Lymphoma

Long-Term Economic Evaluation

PharmacoEconomics volume 28, pages 35–46 (2010)Cite this article

Abstract

Background: Rituximab maintenance therapy was shown to significantly extend overall survival (OS) and progression-free survival (PFS) in relapsed/refractory follicular lymphoma (FL) in the pivotal EORTC 20981 trial.

Objective: To assess the long-term costs and cost effectiveness of rituximab maintenance therapy after induction therapy versus current standard practice (observation) from the French National Health Service perspective.

Methods: A lifetime transition model was developed comparing rituximab maintenance with observation. PFS and OS were obtained from the EORTC 20981 trial with a median follow-up of 28 months and extrapolated from 2-year Kaplan-Meier curves using a Weibull distribution. PFS and OS benefits of rituximab were conservatively assumed to last only 5 years. Utility data were obtained from a multicentre observational study using the EQ-5D questionnaire. Direct medical costs were obtained from French official sources. All costs are reported in €, year 2006 values.

Results: The EORTC 20981 study demonstrated that rituximab maintenance was effective in the management of relapsed/refractory FL. The model results showed that life expectancy and QALYs were increased by 22% and 28%, respectively, in patients treated with rituximab. The incremental cost-effectiveness ratios (ICERs) were €7612 per life-year gained and €8729 per QALY gained. In a oneway sensitivity analysis,most of the ICERs fell within the range of €7000–12 000.

Conclusion: The results tend to show that rituximab maintenance therapy may be a cost-effective strategy in the management of relapsed/refractory FL in France, with ICERs below those observed for other therapies in the oncology field. The cost of rituximab was partly offset by the lower cost of relapse due to a longer time in the disease-free health state for patients in the rituximab arm.

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Acknowledgements

The authors would like to thank Roche France for funding this study.

Houda Miadi-Fargier was an employee of Aremis Consultants at the time of completing the study. Aremis conducted this research under a research grant from Roche France. Professor Deconinck, Professor Le Pen and Dr Brice received support from Roche France. The sponsor played no role in the design or the conduct of the study. Professor Deconinck developed the original idea, provided study material and validated the medical results. Houda Miadi-Fargier carried out the literature search, performed the modelling tasks and wrote the first draft of the manuscript. Professor Le Pen developed the model and made significant inputs to the first draft of the manuscript. Dr Brice provided research assistance and validated the medical hypothesis and modelling results. All authors reviewed and approved the final manuscript.

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Affiliations

  1. INSERM U-645, Université de Franche-Comté, Hematology-CHU Jean Minjoz, Besançon, France

    Eric Deconinck

  2. Aremis Consultants, Neuilly-sur-Seine, France

    Houda Miadi-Fargier

  3. Dauphine University, Paris, France

    Claude Le Pen

  4. Hematology, Saint-Louis Hospital, Paris, France

    Pauline Brice

Authors
  1. Eric Deconinck
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  2. Houda Miadi-Fargier
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  3. Claude Le Pen
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  4. Pauline Brice
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Correspondence to Houda Miadi-Fargier.

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Deconinck, E., Miadi-Fargier, H., Le Pen, C. et al. Cost Effectiveness of Rituximab Maintenance Therapy in Follicular Lymphoma. Pharmacoeconomics 28, 35–46 (2010). https://doi.org/10.2165/11314070-000000000-00000

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  • DOI: https://doi.org/10.2165/11314070-000000000-00000

Keywords

  • Overall Survival
  • Bortezomib
  • Weibull Distribution
  • Follicular Lymphoma
  • Supplemental Digital Content