Economic evaluation of rituximab in addition to standard of care chemotherapy for adult patients with acute lymphoblastic leukemia

Abstract

Aims: Acute lymphoblastic leukemia (ALL) is an aggressive form of leukemia with a poor prognosis in adult patients. The addition of the monoclonal antibody rituximab to standard chemotherapy has been shown to improve survival in adults with ALL. However, it is unknown whether the addition of rituximab is cost-effective. The objective was to determine the economic impact of rituximab in addition to standard of care (SOC) chemotherapy vs SOC alone in newly-diagnosed Philadelphia chromosome-negative, CD20-positive, B-cell precursor ALL.

Methods: A decision analytic model was constructed, based upon the Canadian healthcare system. It included the following health states over a lifetime horizon (max ≈60 years): event-free survival (EFS), relapsed/resistant disease, cure, and death. SOC was either hyper-CVAD or the Dana Farber Cancer Institute (DFCI) ALL consortium. EFS, overall survival, and serious adverse event (SAE) rates were derived from a large randomized controlled trial. Costs of the model included: first-line treatment and administration, disease management, second-line and third-line treatment and administration, palliative care, and SAE-related treatments. Inputs were sourced from provincial and national public data, the literature, and cancer agency input.

Results: Quality-adjusted life-years (QALYs) increased by 2.20 QALYs with rituximab in addition to SOC. The resulting mean Incremental Cost-Effectiveness Ratio (ICER) was C$21,828/QALY. At a willingness-to-pay threshold of C$100,000/QALY, the probability of being cost-effective was 98%. Decision outcomes were robust to the probabilistic and deterministic sensitivity analyses, including the SOC backbone as either hyper-CVAD or DFCI.

Limitations: The results of this analysis are limited by generalizability of the chemotherapy backbone to Canadian practice.

Conclusions: For adults with ALL, rituximab in addition to SOC was found to be a cost-effective intervention, compared to SOC alone. The addition of rituximab is associated with increased life years and increased QALYs at a reasonable incremental cost.

Keywords:

• Leukemia
• cost-effectiveness
• acute lymphoblastic leukemia
• rituximab

Transparency

Declaration of funding

There was no sponsorship or funding to declare Hoffmann-La Roche Limited or otherwise.

Declaration of financial/other relationships

JN, RM, and SY are employees of Hoffmann-La Roche Limited. MG, KP, and MS did not receive compensation from Hoffmann-La Roche Limited for their work on this study and manuscript and have no other relevant disclosures. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

This manuscript is the first disclosure of the full methods and results of this economic evaluation. Some of the methods and results were disclosed by submission of the economic model to the Canadian Agency for Drugs and Technologies in Health (CADTH) as part of a reimbursement health technology assessment; funding recommendation is expected to be published August 31, 2017. In addition, the summary of methods and findings were presented at the CADTH Symposium (April 23–25, 2017; Ottawa, Canada) and the ISPOR 22nd Annual International Meeting (May 20–24, 2017; Boston, MA).