Cost-Effectiveness of Obinutuzumab in Combination with Bendamustine Followed by Obinutuzumab Maintenance versus Bendamustine Alone in Treatment of Patients with Rituximab-Refractory Follicular Lymphoma in Norway

Autor: Audun Ohna, Fredrik Salvesen Haukaas, Tania Krivasi
Rok vydání: 2018
Předmět:
Bendamustine
Oncology
Economics and Econometrics
medicine.medical_specialty
Cost effectiveness
Cost-Benefit Analysis
Antineoplastic Agents
Antibodies
Monoclonal
Humanized
Drug Administration Schedule
Drug Costs
law.invention
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Randomized controlled trial
Obinutuzumab
law
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Medicine
Bendamustine Hydrochloride
Humans
Progression-free survival
Treatment Failure
Lymphoma
Follicular
business.industry
Norway
030503 health policy & services
Health Policy
Hazard ratio
General Medicine
Health Care Costs
Survival Analysis
Progression-Free Survival
Quality-adjusted life year
chemistry
030220 oncology & carcinogenesis
Quality-Adjusted Life Years
Refractory Follicular Lymphoma
0305 other medical science
business
Rituximab
medicine.drug
Zdroj: Applied health economics and health policy. 16(4)
ISSN: 1179-1896
Popis: To evaluate the cost-effectiveness of obinutuzumab in combination with bendamustine followed by obinituzumab maintenance (Obin-Benda) compared to bendamustine alone (Benda) in patients with refractory follicular lymphoma (FL) in a Norwegian setting. A three-state area-under-the-curve (AUC) model was developed. The states included were progression-free-survival (PFS), progressed disease (PD), and death. Each state had costs and utilities assigned to it. The pivotal phase III randomized controlled trial GADOLIN was used for clinical input in the model along with Norwegian cost estimates. The trial demonstrated that Obin-Benda improved overall survival (OS), with a hazard ratio (HR) of 0.67 (95% CI 0.47–0.96), and reduced the likelihood of progression or death (HR 0.52, 95% CI 0.39–0.69) compared to Benda. The model used EQ-5D data collected in the GADOLIN trial, with UK tariffs assigned to the EQ-5D scores. The total quality adjusted life-years (QALYs) for the patients on Obin-Benda were estimated to be 4.67, compared to 3.65 for Benda, while the total costs were estimated to be €98,849 and €51,570, respectively. Obin-Benda had an incremental gain of 1.02 QALYs compared to Benda, at an additional cost of €47,279. The estimated deterministic incremental cost-effectiveness ratio (ICER) was €46,438 per QALY gained, while the probabilistic ICER was €46,887 per QALY gained (95% CI €34,772–€59,443). The results were robust to changes in various sensitivity and scenario analyses. The cost-effectiveness threshold in Norway is not public, but based on previous decisions it is estimated to be up to approximately €89,000 per QALY (NOK 800,000). The results of the analysis indicate that obinutuzumab in combination with bendamustine followed by obinutuzumab maintenance may be cost-effective compared to bendamustine alone in Norway.
Databáze: OpenAIRE
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