Survival benefits of adding rituximab to CHOP are cost-effective

The first cost utility analysis of adding rituximab to standard therapy for patients with diffuse large B-cell non-Hodgkin’s lymphoma (DLBCL) shows that the drug combination is cost-effective in elderly patients.

Dr. John C. Hornberger of Acumen LLC/The SPHERE Institute in Burlingame, Calif., and Jennie H. Best found that adding rituximab to cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) prolonged overall survival by 1.04 years over a 5-year period, with a cost of $19,297 per quality-adjusted year of life gained.”If you’re using the drug in the licensed indication it definitely falls under the criteria of a reasonable public investment,” Dr. Hornberger told Reuters Health in an interview. While putting a dollar figure on years of life saved is obviously controversial and difficult, he added, the standard metric used in the fairly new science of health economics is the cost of a year of life saved by dialysis, estimated at $50,000.Based on this gauge, he added, CHOP-R is clearly cost-effective. However, he adds, the study only looked at current guidelines for the use of the drug in patients 60 and older, and do not apply to off-label use or any situations in which its clinical benefits are not well-established. “We’re talking about the drug used in a setting where there’s good evidence it’s clinically worthwhile,” he added.The introduction of rituximab to CHOP was the first major clinical advance in treating this type of lymphoma in decades, the researchers note in their report in the April 15th issue of Cancer, resulting in a 20% reduction in the risk of death 3 years after diagnosis.Response rate is 76% with CHOP-R compared with 63% with CHOP only, and the response rate has proven durable. Given the increasing adoption of the newer regimen, the researchers set out to determine its cost-effectiveness.They used data from the Groupe d’Etude des Lymphomes Adultes LNH 98-5 study, which included 399 patients, along with other published data on long-term outcome for DLBCL patients, as well as costs for drugs, cancer surveillance and end-of-life care, to evaluate the difference in cost utility between CHOP-R and CHOP alone.While there were additional costs for the drug and for cancer surveillance, there were reductions in expenses for end-of-life and palliative care.”Our analyses show that economics should not be a basis for denying the appropriate use of R-CHOP in the treatment of elderly patients with DLBCL,” the researchers conclude. (Source: Cancer 2005;103:1644-1651: Reuters Health: Oncolink: May 2005.)