Analisi costo-efficacia di rituximab + CHOP versus CHOP in soggetti affetti da linfoma non Hodgkin aggressivo

Cost-effectiveness analysis of rituximab + CHOP versus CHOP in patients with aggressive Non-Hodgkin lymphoma Objective: Aim of this study was to evaluate the cost-effectiveness of rituximab + CHOP (R-CHOP) versus CHOP alone, in Italian patients with aggressive Non-Hodgkin lymphoma (NHL), in the NHS' perspective. Design: The economic analysis is based on an existing Markov model which was developed to evaluate costs and effects for two hypothetical cohorts of patients aged ≥ 60 years or aged < 60 years respectively, over a time frame of 15 years after administration of chemotherapy. The model is based on five health states (start therapy, complete response, no response, progression, death) and combines efficacy data from published clinical trials (GELA-98-5) with costs of therapies and follow-up after chemotherapy, based on Italian treatment patterns. Costs and effects were discounted respectively at 6% and 1.5% per year. Extensive 1-way and Monte Carlo sensitivity analyses were conducted to test the robustness of results. Results: For the two cohorts (age ≥ 60 or age < 60 years), incremental discounted survival gains with R-CHOP vs. CHOP were respectively 1.08 and 1.02 years per patient; incremental QALYs were 1.15 and 1.04 per patient; incremental cost/patient was €14 838 and €13 938; the incremental cost per life-year gained (cost/LYG) was therefore €13 732 and €13 717, while the incremental cost/QALY gained was €12 879 and €13 362. Conclusions: The clinical advantage of R-CHOP is supported by values of incremental cost/LYG and cost/QALY gained, which are well below the thresholds commonly indicated both in the international and Italian literature. R-CHOP is a substantial improvement in the treatment of aggressive NHL, at a reasonable cost, in the perspective of the Italian NHS.