Exploring the potential cost-effectiveness of precision medicine treatment strategies for diffuse large B-cell lymphoma

Abstract

Activated B-cell-like (ABC) diffuse large B-cell lymphoma (DLBCL) is associated with worse survival after standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) chemoimmunotherapy compared to germinal center B-cell-like (GCB) subtype. Preliminary evidence suggests that benefits from novel agents may vary by subtype. Hypothesizing that treatment stratified by DLBCL subtype could be potentially cost-effective, we developed micro-simulation models to compare three first-line treatment strategies: (1) standard RCHOP for all patients (2) subtype testing followed by RCHOP for GCB and novel treatment for ABC DLBCL, and (3) novel treatment for all patients. Based on phase 2 evidence, we used lenalidomide + RCHOP as a surrogate novel treatment. The subtype-based approach showed a favorable incremental cost-effectiveness ratio of $15,015/quality-adjusted life year compared with RCHOP. Although our exploratory analyses demonstrated a wide range of conditions where subtype-based treatment remained cost-effective, data from phase 3 trials are needed to validate our models’ findings and draw definitive conclusions.

Keywords:

• Lymphoma
• diffuse large B-cell lymphoma
• cost-effectiveness
• ABC DLBCL
• subtype testing

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2017.1390230.

Additional information

Funding

Research reported in this publication was supported in part by a Burroughs Wellcome Fund Innovation in Regulatory Science Award, a Healthcare Innovations pilot award through the National Center for Advancing Translational Sciences of the National Institutes of Health under Award number UL1TR000454, and by National Cancer Institute award number K24CA208132 to Dr. Flowers. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.