Cost effectiveness of oral fludarabine in chronic lymphocytic leukaemia: the French case

Summary

The objective was to assess the medicoeconomic impact of initial and subsequent treatments based on oral fludarabine, intravenous chemotherapy (mini-CHOP) and chlorambucil in chronic lymphocytic leukaemia.

A Markov model has been defined to encompass the 18 strategies over a 3-year period after starting the first treatment. Costs of treatments, side effects and follow-up have been calculated by crossing data from published prospective trials, specific hospital databases and French resource-based relative value scales. When treatments were based on mini-CHOP, different possibilities offered for hospital care were taken into account.

Probalistic sensitivity analysis was performed.

Whatever the modality of hospital care for mini-CHOP, the strategies based on oral fludarabine as first-line treatment are not only more effective but are also cost effective and dominate other types of scenarios.

Fludarabine given orally should be preferred to mini-CHOP or chlorambucil as a first-line treatment for patients with chronic lymphocytic leukaemia.

Keywords:

• chlorambucil
• chronic lymphocytic leukaemia
• cost effectiveness
• fludarabine
• mini-CHOP