Details

Autor(en) / Beteiligte

• Kambhampati, Swetha
• Saumoy, Monica
• Schneider, Yecheskel
• Pak, Stacy
• Budde, Lihua Elizabeth
• Mei, Matthew G.
• Siddiqi, Tanya
• Popplewell, Leslie L.
• Wen, Yi-Ping
• Zain, Jasmine
• Forman, Stephen J.
• Kwak, Larry W.
• Rosen, Steven T.
• Danilov, Alexey V.
• Herrera, Alex F.
• Thiruvengadam, Nikhil R.

Titel

Cost-effectiveness of polatuzumab vedotin combined with chemoimmunotherapy in untreated diffuse large B-cell lymphoma

Ist Teil von

• Blood, 2022-12, Vol.140 (25), p.2697-2708

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2022

Quelle

EZB-FREE-00999 freely available EZB journals

Beschreibungen/Notizen

• •Pola-R-CHP is provisionally cost-effective compared with R-CHOP for the frontline treatment of DLBCL at a WTP of $150 000/QALY.•The cost-effectiveness of pola-R-CHP depends on its long-term outcomes (5-year PFS of at least 66.1% needed to remain cost-effective). [Display omitted] In patients with treatment-naive diffuse large B-cell lymphoma (DLBCL), the POLARIX study (A Study Comparing the Efficacy and Safety of Polatuzumab Vedotin With Rituximab-Cyclophosphamide, Doxorubicin, and Prednisone [R-CHP] Versus Rituximab-Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone [R-CHOP] in Participants With Diffuse Large B-Cell Lymphoma) reported a 6.5% improvement in the 2-year progression-free survival (PFS), with no difference in overall survival (OS) or safety using polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) compared with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). We evaluated the cost-effectiveness of pola-R-CHP for DLBCL. We modeled a hypothetical cohort of US adults (mean age, 65 years) with treatment-naive DLBCL by developing a Markov model (lifetime horizon) to model the cost-effectiveness of pola-R-CHP and R-CHOP using a range of plausible long-term outcomes. Progression rates and OS were estimated from POLARIX. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay (WTP) threshold of $150 000 per quality-adjusted life-year (QALY). Assuming a 5-year PFS of 69.6% with pola-R-CHP and 62.7% with R-CHOP, pola-R-CHP was cost-effective at a WTP of $150 000 (incremental cost-effectiveness ratio, $84 308/QALY). pola-R-CHP was no longer cost-effective if its 5-year PFS was 66.1% or lower. One-way sensitivity analysis revealed that pola-R-CHP is cost-effective up to a cost of $276 312 at a WTP of $150 000. pola-R-CHP was the cost-effective strategy in 56.6% of the 10 000 Monte Carlo iterations at a WTP of $150 000. If the absolute benefit in PFS is maintained over time, pola-R-CHP is cost-effective compared with R-CHOP at a WTP of $150 000/QALY. However, its cost-effectiveness is highly dependent on its long-term outcomes and costs of chimeric antigen receptor T-cell therapy. Routine usage of pola-R-CHP would add significantly to health care expenditures. Price reductions or identification of subgroups that have maximal benefit would improve cost-effectiveness. Kambhampati and colleagues examine the cost-effectiveness of the inclusion of polatuzumab vedotin (pola-R-CHP) in therapy for treatment-naïve diffuse large B-cell lymphoma. The POLARIX study showed a 6.5% improvement in 2-year progression-free survival (PFS) with no difference in overall survival using pola-R-CHP compared to R-CHOP. In their model, pola-R-CHP is cost-effective in 56.6% of iterations, suggesting marginal cost-effectiveness that is highly dependent on long-term PFS projections and the cost of CAR T-cell therapy.