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      Treatment of follicular non-Hodgkin's lymphoma with or without rituximab: cost-effectiveness and value of information based on a 5-year follow-up

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          Abstract

          Background: Rituximab induction together with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and rituximab maintenance (RCHOP-R) resulted to significant progression-free survival (PFS) benefit in comparison to RCHOP in the EORTC20981 trial of relapsed/refractory follicular non-Hodgkin's lymphoma (FL). However, the overall survival (OS) difference between RCHOP-R and RCHOP was insignificant. This study evaluated the cost-effectiveness of RCHOP, RCHOP-R, and CHOP in the treatment of relapsed/refractory FL.

          Design: A lifetime Markov modeling based on the 5-year EORTC20981 survivals (Weibull regressions) was carried out from the public health care payer perspective. Finnish costs (drug, routine, adverse event, and relapse management) were employed. The main outcomes were incremental cost (€2008) per quality-adjusted life-year (QALY), progression-free year (PFY), and life-years gained (LYG). Analyses included cost-effectiveness acceptability frontier and multinomial expected value of perfect information (mEVPI).

          Results: RCHOP-R resulted to OS (PFS) benefit compared with RCHOP and CHOP: 6 (10) and 17 (25) months, respectively. The incremental costs per QALY gained/LYG/PFY gained were €18 147/€16 380/€10 416 for RCHOP-R versus RCHOP (mEVPI €5196); €14 360/€13 041/€8976 for RCHOP-R versus CHOP (mEVPI €1986); and €12 123/€11 049/€8004 for RCHOP versus CHOP (mEVPI €1,240). RCHOP-R was the optimal option when the willingness to pay per QALY gained exceeded €18 399.

          Conclusion: RCHOP-R is a potentially cost-effective treatment option for the FL.

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          Decision Modelling for Health Economic Evaluation

          Andrew H Briggs, Karl Claxton, Mark J Sculpher (2006)
          In financially constrained health systems across the world, increasing emphasis is being placed on the ability to demonstrate that health care interventions are not only effective, but also cost-effective. This book deals with decision modelling techniques that can be used to estimate the value for money of various interventions including medical devices, surgical procedures, diagnostic technologies, and pharmaceuticals. Particular emphasis is placed on the importance of the appropriate representation of uncertainty in the evaluative process and the implication this uncertainty has for decision making and the need for future research. This highly practical guide takes the reader through the key principles and approaches of modelling techniques. It begins with the basics of constructing different forms of the model, the population of the model with input parameter estimates, analysis of the results, and progression to the holistic view of models as a valuable tool for informing future research exercises. Case studies and exercises are supported with online templates and solutions. This book will help analysts understand the contribution of decision-analytic modelling to the evaluation of health care programmes. [Ed.]
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            The impact of 29 chronic conditions on health-related quality of life: a general population survey in Finland using 15D and EQ-5D.

            Samuli Saarni, Jouko Lönnqvist, Harri Sintonen … (2006)
            Health-related quality of life (HRQoL) is an essential outcome of health care, but there is no gold standard of HRQoL measurement. We investigated the impact of major chronic conditions on HRQoL using 15D and EQ-5D in a representative sample of Finns. Information on chronic somatic conditions was obtained by interviews. Psychiatric disorders were diagnosed using a structured interview (M-CIDI). Tobit and CLAD regression analysis was used to estimate the impact of conditions on HRQoL at the individual and population level. Adjusted for other conditions and sociodemographic variables, Parkinson's disease had the largest negative impact on HRQoL at the individual level, followed by anxiety disorders, depressive disorders and arthrosis of the hip and knee. Based on prevalence, arthrosis of the hip or knee, depression, back problems and urinary incontinence caused the greatest loss of HRQoL at the population level. The results obtained with the two HRQoL measures differed markedly for some conditions and the EQ-5D results also varied with the regression method used. Musculoskeletal disorders are associated with largest losses of HRQoL in the Finnish population, followed by psychiatric conditions. Different HRQoL measures may systematically emphasize different conditions.
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              From the bench to the bedside: ways to improve rituximab efficacy.

              Philippe Solal-Celigny, Josee Golay, Hervé Watier … (2004)
              Rituximab (MabThera, Rituxan) is a chimeric IgG1 monoclonal antibody that specifically targets the CD20 surface antigen expressed on normal and neoplastic B-lymphoid cells. Rituximab is currently used in the treatment of both follicular and aggressive B-cell non-Hodgkin lymphomas. Despite its demonstrated clinical effectiveness, its in vivo mechanisms of action remain unknown and could differ by subtype of lymphoma. Rituximab has been shown to induce apoptosis, complement-mediated lysis, and antibody-dependent cellular cytotoxicity in vitro, and some evidence points toward an involvement of these mechanisms in vivo. Rituximab also has a delayed therapeutic effect as well as a potential "vaccinal" effect. Here, we review the current understanding of the mechanism of action of rituximab and discuss approaches that could increase its clinical activity. A better understanding of how rituximab acts in vivo should make it possible to develop new and more effective therapeutic strategies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Oncol
                Journal ID (hwp): annonc
                Journal ID (publisher-id): annonc
                Title: Annals of Oncology
                Publisher: Oxford University Press
                ISSN (Print): 0923-7534
                ISSN (Electronic): 1569-8041
                Publication date (Print): May 2011
                Publication date (Electronic): 06 December 2010
                Publication date PMC-release: 06 December 2010
                Volume: 22
                Issue: 5
                Pages: 1189-1197
                Affiliations
                [1 ]ESiOR Oy
                [2 ]School of Pharmacy, University of Eastern Finland
                [3 ]Department of Medicine, Kuopio University Hospital and University of Kuopio, Kuopio, Finland
                Author notes
                [* ] Correspondence to: Mr. E. J. O. Soini, ESiOR Ltd, PO Box 1188 (Microkatu 1), FI-70211 Kuopio, Finland. Tel: +358-40-053-3971; E-mail: erkki.soini@ 123456esior.fi
                Article
                DOI: 10.1093/annonc/mdq582
                PMC ID: 3082160
                PubMed ID: 21135053
                SO-VID: a443e561-7cd0-425e-9164-2cf6dce66629
                Copyright © © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 May 2010
                Date revision received : 18 August 2010
                Date accepted : 20 August 2010
                Categories
                Subject: Original Articles
                Subject: Hematologic Malignancies

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: cancer,rituximab,chemotherapy,opportunity cost,review,economic evaluation,lymphoma,maintenance
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: cancer, rituximab, chemotherapy, opportunity cost, review, economic evaluation, lymphoma, maintenance

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