Cost-effectiveness of rituximab as maintenance treatment for relapsed follicular lymphoma: results of a population-based study

Objectives On the basis of two population-based registries, our study aims to calculate the real-world cost-effectiveness of rituximab maintenance compared with observation in relapsed or refractory follicular lymphoma patients who responded to second-line chemotherapy. Methods Data were obtained from the EORTC20981 trial, the Netherlands Cancer Registry and two population-based registries. A Markov model was developed to calculate cost per life year gained (LYG) and quality-adjusted life years (QALYs) for three scenarios. Results Our real-world patients were (62years) 6 to 7years older and had higher complete response rates to second-line chemotherapy than the trial population. Differences between the real-world rituximab and observation group were observed for second-line chemotherapy and disease progression. Groups were more balanced after using propensity matching. Relying entirely on updated trial results (scenario1) in combination with local cost data resulted in ratios of euro11259 per LYG and euro12655 per QALY. For scenario2, consisting of trial efficacy and matched real-world costs, ratios of euro21202 per LYG and euro23821 per QALY were calculated. Using real-world matched evidence (scenario3) for both effectiveness and costs showed ratios of euro10591 per LYG and euro11245 per QALY. Conclusion Although differences in real-world and trial population were found, using real-world data as well as results from long-term trial follow-up showed favourable ICERs for rituximab maintenance. Nevertheless, results showed that caution is required with data synthesis, interpretation and generalisability of results. As different scenarios provide answers to different questions, we recommend healthcare decision-makers to recognise the importance of calculating several cost-effectiveness scenarios.