Cost-effectiveness analysis of rituximab with methotrexate, cytarabine and thiotepa for the treatment of patients with primary central nervous system lymphoma

Abstract

The International Extranodal Lymphoma Study Group-32 (IELSG32) randomized patients with primary central nervous system lymphoma (PCNSL) for induction treatment with methotrexate-cytarabine, methotrexate-cytarabine-rituximab, or methotrexate-cytarabine-thiotepa-rituximab (MATRix) and reported significantly improved complete remission with the MATRix regimen. This study assessed cost-effectiveness among these three induction strategies for PCNSL. A Markov model was developed based on the IELSG32 trial over a 20 year time horizon from the Canadian health care system perspective. Costs for induction, consolidation, inpatient treatment administration, follow-up, adverse events, relapsed disease, and palliative care were included. Methotrexate-cytarabine-rituximab was subject to extended dominance by the other two strategies. The MATRix regimen compared to methotrexate-cytarabine produced 3.05 quality-adjusted life year (QALY) gains at added costs of $75,513, resulting in an incremental cost-effectiveness ratio of $24,758/QALY gained. The MATRix regimen was the optimal strategy in the majority of simulations (98% probability at willingness-to-pay of $50,000/QALY gained) and results appeared robust across sensitivity analyses.

Keywords:

• Primary CNS lymphoma
• cost-effectiveness analysis
• Markov
• chemotherapy

Acknowledgements

We would like to acknowledge the helpful contributions of members of Cancer Care Ontario’s Hematology Drug Advisory Committee in validating clinical and costing assumptions used within this analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was conducted with the support of Cancer Care Ontario, which is funded by the Ontario Ministry of Health and Long-Term Care. The opinions, results, view, and conclusions reported in this publication are those of the authors and do not necessarily reflect those of Cancer Care Ontario. No endorsement by Cancer Care Ontario is intended or should be inferred.