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. 2021 Jul 22:13:661-671.
doi: 10.2147/CEOR.S317885. eCollection 2021.

Obinutuzumab Plus Chemotherapy Compared with Rituximab Plus Chemotherapy in Previously Untreated Italian Patients with Advanced Follicular Lymphoma at Intermediate-High Risk: A Cost-Effectiveness Analysis

Marco Bellone  1 , Lorenzo Pradelli  1 , Stefano Molica  2 , Adele Emanuela De Francesco  3 , Daniela Ghislieri  4 , Emanuele Guardalben  5 , Antonietta Caputo  4
Affiliations

Obinutuzumab Plus Chemotherapy Compared with Rituximab Plus Chemotherapy in Previously Untreated Italian Patients with Advanced Follicular Lymphoma at Intermediate-High Risk: A Cost-Effectiveness Analysis

Marco Bellone et al. Clinicoecon Outcomes Res. .

Abstract

Objective: To assess the cost-effectiveness of obinutuzumab (O-chemo) in comparison to rituximab (R-chemo) in patients with untreated advanced follicular lymphoma (FL) at intermediate or high risk from an Italian National Health Service (NHS) perspective.

Methods: A previously developed four-state Markov model was adapted to estimate lifetime clinical outcomes and costs of Italian patients with advanced FL and an FL international predictive index score ≥2 in treatment with O-chemo and R-chemo. Life expectancy was derived from the GALLIUM and PRIMA clinical trials. Progression-free survival (PFS), early progressive disease (PD), and treatment duration were extrapolated by fitting parametric distributions to empirical data in GALLIUM and late PD to data in PRIMA. Expected survival was weighed by published utilities. Costs updated to 2020 Euros and health gains occurring after the first year were discounted at an annual 3% rate. Probabilistic sensitivity analysis (PSA) was carried out.

Results: O-chemo was associated with an incremental survival increase (0.97 life-years [LYs]), even when weighted for quality (0.88 quality-adjusted LYs [QALYs]), and incremental costs (around €15,000), driven by longer treatment during PFS state relative to R-chemo. The incremental cost-effectiveness ratio and incremental cost-utility ratio are both widely accepted by the Italian NHS (around €15,500/LY and €17,000/QALY gained, respectively). PSA simulations confirmed the robustness of results given sensible variations in assumptions.

Conclusion: O-chemo has superior clinical efficacy compared to rituximab, and should be considered a cost-effective option in first-line treatment of patients with advanced FL at intermediate or high risk in Italy. Incremental cost-effectiveness ratios are below the threshold considered affordable by developed countries.

Keywords: FLIPI score; ICER; PFS; QALY; economic evaluation; oncology.

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Conflict of interest statement

Dr Marco Bellone is an employee of AdRes, which has received project funding from Roche for the development of this research. Dr Marco Bellone reports grants from Roche during the study and grants from Roche, Sanofi, Janssen-Cilag Spa, Fresenius Kabi Deutschland, Novartis Farma, and Fresenius Kabi Italia outside the submitted work. Dr Lorenzo Pradelli is co-owner and an employee of AdRes, which has received project funding from Roche for the development of this research. Dr Lorenzo Pradelli report grants from Roche Spa during the study and grants from Janssen-Cilag, Sanofi, AstraZeneca, Biogen, and Medtronic outside the submitted work. Drs Stefano Molica and Adele Emanuela De Francesco are consultants for Roche. Drs Daniela Ghislieri, Emanuele Guardalben, and Antonietta Caputo are employees of Roche. The abstract of this paper was presented at the ISPOR Europe 2019 as a poster presentation, and can be viewed here: https://doi.org/10.1016/j.jval.2019.09.352

Figures

Figure 1
Figure 1
Model structure. Arrows indicate possible transitions through health states. “On treatment” and “Off treatment” are subcategories of health states included in PFS.
Figure 2
Figure 2
Estimated survival curves based on GALLIUM study: Markov trace and time in health state.
Figure 3
Figure 3
Cost-effectiveness plane.
Figure 4
Figure 4
Probability of being the most cost-effective treatment.
See this image and copyright information in PMC

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