Cost‐minimization analysis of CHOP, fludarabine and rituximab for the treatment of relapsed indolent B‐cell non‐Hodgkin's lymphoma in the U.K.

Abstract

Summary. The optimal therapy for patients with relapsed indolent B-cell non-Hodgkin's lymphoma is unclear. Combination chemotherapy such as CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) or purine analogues including¯udarabine are frequently used and the anti-CD20 monoclonal antibody rituximab has recently been licensed for use. However, no comparative studies of these therapies have been reported. Since relapsed indolent B-cell NHL is generally regarded as incurable with current therapies, the place of each of these therapies is likely to be determined by their relative ef®cacy, toxicity and cost. We undertook a literature review and a retrospective analysis of patients receiving combination chemotherapy for relapsed indolent B-cell NHL at our institution to determine the response rates and the duration of response when treated with CHOP or udarabine. Reported response rates and median response duration for these regimens are similar, and similar to those reported in phase II studies of rituximab. A cost minimization analysis was therefore conducted.The per patient costs for the treatment of drug-related adverse events were £5049 for CHOP, £2953 for¯udarabine and £109 for rituximab. When costs of a full course of each treatment were compared, the costs per patient for CHOP, udarabine and rituximab were £7210 (£5975±8445), £10022 (£8917±11126) and £6080 (£5892±6267) respectively. In this preliminary analysis, rituximab appeared to have a similar ef®cacy rate to CHOP and¯udarabine, but had signi®cantly fewer adverse events and a lower total cost per patient. These data require con®rmation in a prospective randomized study with formal assessment of costeffectiveness.

Rituximab (MabThera®) for aggressive non-Hodgkin's lymphoma: systematic review and economic evaluation

“…The drug cost of CHOP has been derived from papers by Sweetenham and colleagues 83 and Beard and colleagues. 84 The cost per course of CHOP based on Sweetenham and colleagues was £172.50, whereas Beard and colleagues estimated the cost to be £160, ranging to £283 if one assumes a 50% chance of neutropenic sepsis.…”

Costs of Chemotherapy for Indolent Follicular Non-Hodgkin’s Lymphoma in the UK: An Observational Study

“…Herold et al [12, 13] reported costs for Canada, Germany and Italy, and it is difficult to compare these findings with our own. Sweetenham et al [15] reported the findings of a UK cost-minimization analysis comparing CHOP, fludarabine and rituximab with costs (in 1998) calculated from the perspective of the hospital. CHOP and fludarabine treatment costs were estimated from resource events occurring in one cycle of treatment while rituximab costs were calculated on the basis of trial data collected across the whole treatment period.…”

“…Secondly, the unit costs associated with OP episodes were varied by ±20%. This method follows the sensitivity analyses in previous studies [15, 18] and explores variations in cost between different trusts [6]. Thirdly, we included the cost of AEs occurring after the end of active treatment.…”

“…Previous studies have considered the cost of therapies for indolent follicular NHL [12,13,14,15]. Based on a retrospective chart review of relapsed follicular NHL patients in Canada, Germany and Italy, Herold et al [12, 13] reported the average cost of treatment per patient for fludarabine, CVP and CHOP.…”

“…Based on a retrospective chart review of relapsed follicular NHL patients in Canada, Germany and Italy, Herold et al [12, 13] reported the average cost of treatment per patient for fludarabine, CVP and CHOP. Sweetenham et al [15] reported the findings of a UK cost-minimization analysis of CHOP, fludarabine and rituximab in the management of patients with relapsed follicular NHL. However, the majority of costs in these studies were estimated by extrapolating from a single cycle of therapy or from settings that differ from usual practice in the UK.…”