Pharmacoeconomic Evaluation on Chemotherapy Combined with Rituximab for Non-Hodgkin’s Lymphoma: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 SUN Yankun ¹ , Gordon L. Liu ² , LI Youping ³

1. Peking University China Center for Health Economic Research, Beijing 100871, China; 2. Peking University Guanghua School of Management, PKU China Center for Health Economic Research, Beijing 100871, China; 3. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

SUN Yankun, Email: yankunsun@gmail.com

Keywords：

Pharmacoeconomics; Non-Hodgkin’s lymphomas; Rituximab; Systematic review

DOI：

10.7507/1672-2531.20130125

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically evaluate the pharmacoeconomic vaule of chemotherapy combined with rituximab for patients with non-Hodgkin’s lymphomas (NHL).
Methods 　A systematic literature search of cost-effectiveness studies on rituximab treating NHL published from 1998 to 2012 was carried out in following databases: PubMed, ScienceDirect, Health Technology Assessment (HTA) and Cochrane Database of Systematic Reviews (CDSR). And the references of included studies were also retrieved manually. The studies were screened according to the pre-designed inclusion and exclusion criteria, and the incremental cost- effectiveness ratio (ICER) in comparison between chemotherapy plus rituximab and chemotherapy alone was systematically evaluated according to the literature evaluation index system.
Results 　The average ICER of Rituximab treating NHL was
16 318/QALY,
17 688/QALY, and
22 461/QALY in the UK, Mainland Europe, and US, respectively. All the reported ICERs in the included studies were below the implemented country-specific thresholds.
Conclusion 　Based on present foreign literature, the integrated therapy of chemotherapy and rituximab for NHL is supposed to be a better cost-effective therapy with ICER below the implemented country-specific thresholds.

Citation： SUN Yankun,Gordon L. Liu,LI Youping. Pharmacoeconomic Evaluation on Chemotherapy Combined with Rituximab for Non-Hodgkin’s Lymphoma: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(6): 700-708. doi: 10.7507/1672-2531.20130125 Copy

1.	Timothy C. non-Hodgkin’s lymphoma. Cancer, 1995, 1(suppl): 370.
2.	Marky I, Schmiegelow K, Perkkio M, et al. Childhood non-Hodgkin’s lymphoma in the five Nordic countries. J pediatr Hematol Oncol, 1995, 17(2): 163.
3.	孙曾一. 恶性淋巴瘤的流行病学. 实用肿瘤学杂志, 1989, 4(4).
4.	董国贤, 姚文庆, 黎均耀. 沈阳地区恶性淋巴瘤发病因素的研究. 实用肿瘤学杂志, 1988, 2(4): 268.
5.	中华医学会血液学分会. 中国弥漫大B细胞诊断与治疗指南. 2011.
6.	中华医学会血液学分会. 中国滤泡性淋巴瘤诊断与治疗指南. 2011.
7.	Gross S A, Zhu X Z, Bao L, et al. A prospective study of 728 cases of non-Hodgkin lymphoma from a single laboratory in Shanghai, China. Int J Hematol, 2008, 88(22): 165-173.
8.	李旸, 刘卓刚, 郝良纯, 等. 中国非霍奇金淋巴瘤患者行利妥昔单抗联合CHOP方案化疗疗效与安全性的 Meta分析. 循证医学, 2011, 11(2): 112-116.
9.	石浩强, 沈阳, 叶莹琼, 等. 利妥昔单抗对于非霍奇金淋巴瘤的治疗及其药物经济学. 药学服务与研究, 2007, 7(5): 332-334.
10.	Papaioannou D, Rafia R, Rathbone J, et al. Rituximab for the first-line treatment of stage III-IV follicular lymphoma a systematic review and economic evaluation. 2012.
11.	Best JH, Hornberger J, Proctor SJ, et al. Cost-effectiveness analysis of rituximab combined with chop for treatment of diffuse large B-cell lymphoma. Value Health, 2005, 8(4): 462-470.
12.	Bagust A, Boland A, Hockenhull J, et al. Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2009, 13 Suppl 2: 41-48.
13.	Deconinck E, Miadi-Fargier H, Pen CL, et al.Cost effectiveness of rituximab maintenance therapy in follicular lymphoma: long-term economic evaluation. Pharmacoeconomics, 2010, 28(1): 35-46.
14.	Hayslip JW, Simpson KN. Cost-effectiveness of extended adjuvant rituximab for US patients aged 65-70 years with follicular lymphoma in second remission. Clin Lymphoma Myeloma, 2008, 8(3): 166-170.
15.	Kasteng F, Erlanson M, Hagberg H, et al. Cost-effectiveness of maintenance rituximab treatment after second line therapy in patients with follicular lymphoma in Sweden. Acta Oncol, 2008, 47(6): 1029-1036.
16.	Dundar Y, Bagust A, Hounsome J, et al. Rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2009, 13 Suppl 1: 23-28.
17.	Ferrara F, Ravasio R. Cost-effectiveness analysis of the addition of rituximab to CHOP in young patients with good-prognosis diffuse large-B-cell lymphoma. Clin Drug Investig, 2008, 28(1): 55-65.
18.	Hornberger JC, Best JH. Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma. Cancer, 2005, 103(8): 1644-1651.
19.	Hornberger J, Reyes C, Lubeck D, et al. Economic evaluation of rituximab plus cyclophosphamide, vincristine and prednisolone for advanced follicular lymphoma. Leuk Lymphoma, 2008, 49(2): 227-236.
20.	Knight C, Hind D, Brewer N, et al. Rituximab (MabThera) for aggressive non-Hodgkin’s lymphoma: systematic review and economic evaluation. Health Technol Assess, 2004, 8(37): 1-82.
21.	Ray J, Carr E, Lewis G, et al. An evaluation of the cost-effectiveness of rituximab in combination with chemotherapy for the first-line treatment of follicular non-Hodgkin’s lymphoma in the UK. Value Health, 2010, 13(4): 346-357.
22.	Grupo de Farmacoeconomía del Linfoma Folicular. [Rituximab cost analysis for maintenance treatment of patients with follicular lymphoma]. [Article in Spanish]. Farm Hosp, 2008, 32(1): 25-34.
23.	Soini EJ, Martikainen JA, nousiainen T. Treatment of follicular non-Hodgkin’s lymphoma with or without rituximab: cost-effectiveness and value of information based on a 5-year follow-up. Ann Oncol, 2011, 22(5): 1189-1197.
24.	Bagust A, Boland A, Blundell M, et al. Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2010.
25.	Groot MT, Lugtenburg PJ, Hornberger J, et al. Cost-effectiveness of rituximab (MabThera) in diffuse large B-cell lymphoma in The Netherlands. Eur J Haematol, 2005, 74(3): 194-202.
26.	Van Oers MH, Klasa R, Marcus RE, et al. Rituximab maintenance improves clinical outcomes of relapsed/resistant follicular non-Hodgkin’s lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood, 2006, 108: 3295-3301.
27.	Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med, 2002, 346: 235–242.
28.	Marcus R, Imrie K, Belch A, et al. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood, 2005, 105: 1417-1423.
29.	Pfreundschuh M, Trumper L, Osterborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol, 2006, 7: 379-391.
30.	Marcus R, Imrie K, Solal-Celigny P, et al. Phase III study of R-CVP compared with cyclophosphamide vincristine prednisone alone in patients with previously untreated advanced follicular lymphoma. J Clin Oncol, 2008, 26: 4579-4586.
31.	Hiddemann W, Kneba M, Dreyling M, et al. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low Grade Lymphoma Study Group. Blood, 2005, 106: 3725-3732.
32.	Herold M, Haas A, Srock S, et al. Rituximab added to first-line mitoxantrone, chlorambucil, and prednisolone chemotherapy followed by interferon maintenance prolongs survival in patients with advanced follicular lymphoma: an East German Study Group Hematology and Oncology Study. J Clin Oncol, 2007, 25(15): 1986-1992.
33.	Salles G, Mounier N, de Guibert S, et al. Rituximab combined with chemotherapy and interferon in follicular lymphoma patients: results of the GELA-GOELAMSFL2000 study. Blood, 2008, 112: 4824-4831.

1. Timothy C. non-Hodgkin’s lymphoma. Cancer, 1995, 1(suppl): 370.
2. Marky I, Schmiegelow K, Perkkio M, et al. Childhood non-Hodgkin’s lymphoma in the five Nordic countries. J pediatr Hematol Oncol, 1995, 17(2): 163.
3. 孙曾一. 恶性淋巴瘤的流行病学. 实用肿瘤学杂志, 1989, 4(4).
4. 董国贤, 姚文庆, 黎均耀. 沈阳地区恶性淋巴瘤发病因素的研究. 实用肿瘤学杂志, 1988, 2(4): 268.
5. 中华医学会血液学分会. 中国弥漫大B细胞诊断与治疗指南. 2011.
6. 中华医学会血液学分会. 中国滤泡性淋巴瘤诊断与治疗指南. 2011.
7. Gross S A, Zhu X Z, Bao L, et al. A prospective study of 728 cases of non-Hodgkin lymphoma from a single laboratory in Shanghai, China. Int J Hematol, 2008, 88(22): 165-173.
8. 李旸, 刘卓刚, 郝良纯, 等. 中国非霍奇金淋巴瘤患者行利妥昔单抗联合CHOP方案化疗疗效与安全性的 Meta分析. 循证医学, 2011, 11(2): 112-116.
9. 石浩强, 沈阳, 叶莹琼, 等. 利妥昔单抗对于非霍奇金淋巴瘤的治疗及其药物经济学. 药学服务与研究, 2007, 7(5): 332-334.
10. Papaioannou D, Rafia R, Rathbone J, et al. Rituximab for the first-line treatment of stage III-IV follicular lymphoma a systematic review and economic evaluation. 2012.
11. Best JH, Hornberger J, Proctor SJ, et al. Cost-effectiveness analysis of rituximab combined with chop for treatment of diffuse large B-cell lymphoma. Value Health, 2005, 8(4): 462-470.
12. Bagust A, Boland A, Hockenhull J, et al. Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2009, 13 Suppl 2: 41-48.
13. Deconinck E, Miadi-Fargier H, Pen CL, et al.Cost effectiveness of rituximab maintenance therapy in follicular lymphoma: long-term economic evaluation. Pharmacoeconomics, 2010, 28(1): 35-46.
14. Hayslip JW, Simpson KN. Cost-effectiveness of extended adjuvant rituximab for US patients aged 65-70 years with follicular lymphoma in second remission. Clin Lymphoma Myeloma, 2008, 8(3): 166-170.
15. Kasteng F, Erlanson M, Hagberg H, et al. Cost-effectiveness of maintenance rituximab treatment after second line therapy in patients with follicular lymphoma in Sweden. Acta Oncol, 2008, 47(6): 1029-1036.
16. Dundar Y, Bagust A, Hounsome J, et al. Rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2009, 13 Suppl 1: 23-28.
17. Ferrara F, Ravasio R. Cost-effectiveness analysis of the addition of rituximab to CHOP in young patients with good-prognosis diffuse large-B-cell lymphoma. Clin Drug Investig, 2008, 28(1): 55-65.
18. Hornberger JC, Best JH. Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma. Cancer, 2005, 103(8): 1644-1651.
19. Hornberger J, Reyes C, Lubeck D, et al. Economic evaluation of rituximab plus cyclophosphamide, vincristine and prednisolone for advanced follicular lymphoma. Leuk Lymphoma, 2008, 49(2): 227-236.
20. Knight C, Hind D, Brewer N, et al. Rituximab (MabThera) for aggressive non-Hodgkin’s lymphoma: systematic review and economic evaluation. Health Technol Assess, 2004, 8(37): 1-82.
21. Ray J, Carr E, Lewis G, et al. An evaluation of the cost-effectiveness of rituximab in combination with chemotherapy for the first-line treatment of follicular non-Hodgkin’s lymphoma in the UK. Value Health, 2010, 13(4): 346-357.
22. Grupo de Farmacoeconomía del Linfoma Folicular. [Rituximab cost analysis for maintenance treatment of patients with follicular lymphoma]. [Article in Spanish]. Farm Hosp, 2008, 32(1): 25-34.
23. Soini EJ, Martikainen JA, nousiainen T. Treatment of follicular non-Hodgkin’s lymphoma with or without rituximab: cost-effectiveness and value of information based on a 5-year follow-up. Ann Oncol, 2011, 22(5): 1189-1197.
24. Bagust A, Boland A, Blundell M, et al. Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma. Health Technol Assess, 2010.
25. Groot MT, Lugtenburg PJ, Hornberger J, et al. Cost-effectiveness of rituximab (MabThera) in diffuse large B-cell lymphoma in The Netherlands. Eur J Haematol, 2005, 74(3): 194-202.
26. Van Oers MH, Klasa R, Marcus RE, et al. Rituximab maintenance improves clinical outcomes of relapsed/resistant follicular non-Hodgkin’s lymphoma in patients both with and without rituximab during induction: results of a prospective randomized phase 3 intergroup trial. Blood, 2006, 108: 3295-3301.
27. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med, 2002, 346: 235–242.
28. Marcus R, Imrie K, Belch A, et al. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood, 2005, 105: 1417-1423.
29. Pfreundschuh M, Trumper L, Osterborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol, 2006, 7: 379-391.
30. Marcus R, Imrie K, Solal-Celigny P, et al. Phase III study of R-CVP compared with cyclophosphamide vincristine prednisone alone in patients with previously untreated advanced follicular lymphoma. J Clin Oncol, 2008, 26: 4579-4586.
31. Hiddemann W, Kneba M, Dreyling M, et al. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low Grade Lymphoma Study Group. Blood, 2005, 106: 3725-3732.
32. Herold M, Haas A, Srock S, et al. Rituximab added to first-line mitoxantrone, chlorambucil, and prednisolone chemotherapy followed by interferon maintenance prolongs survival in patients with advanced follicular lymphoma: an East German Study Group Hematology and Oncology Study. J Clin Oncol, 2007, 25(15): 1986-1992.
33. Salles G, Mounier N, de Guibert S, et al. Rituximab combined with chemotherapy and interferon in follicular lymphoma patients: results of the GELA-GOELAMSFL2000 study. Blood, 2008, 112: 4824-4831.

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Pharmacoeconomic Evaluation on Chemotherapy Combined with Rituximab for Non-Hodgkin’s Lymphoma: A Systematic Review

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