Cost-effectiveness of adding rituximab to fludarabine and cyclophosphamide for the treatment of previously untreated chronic lymphocytic leukemia

Abstract

A recent phase III trial demonstrated improved progression-free survival (PFS) and overall survival (OS) associated with adding rituximab to fludarabine and cyclophosphamide (R-FC) compared to FC in treatment of previously untreated chronic lymphocytic leukemia (CLL). A cost-effectiveness analysis of R-FC over FC was performed from a US third-party payer perspective over a lifetime horizon in the base case. One-way, two-way and probabilistic sensitivity analyses were conducted to assess the robustness of the results. A secondary analysis was performed by also considering a societal perspective. R-FC was associated with an incremental 1.15 quality-adjusted life-years (QALYs) compared to FC and resulted in an incremental cost-effectiveness ratio of $23 530 per QALY in the base case and $31 513 per QALY considering a societal perspective. Results were most sensitive to time horizon, discount rate and unit drug cost for rituximab. Within the limitations of modeling long-term outcomes, R-FC is cost-effective for previously untreated CLL.

Keywords::

• Cost-effectiveness
• rituximab
• chronic lymphocytic leukemia
• previously untreated
• fludarabine
• cyclophosphamide

Acknowledgement

The study was funded by Genentech, Inc.

Potential conflict of interest:

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

Appendix

Appendix Table I. Ranges for parameters and effect on ICER for one-way sensitivity analysis.

Appendix Table II. Distribution of parameters for probabilistic sensitivity analyses.

Appendix Figure 1. Scatterplot (a) and acceptability curve (b) from probabilistic sensitivity analysis. QALY, quality-adjusted life-year.