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Rituximab improves survival in NHL but doesn’t save money, new analysis finds

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In real-world patients with diffuse large B-cell lymphoma (DLBCL), the most common subtype of non-Hodgkin lymphoma (NHL), adding rituximab to first-line chemotherapy improves survival, but it’s not necessarily going to yield cost savings, a new analysis suggests.

In a telephone interview with Reuters Health, Dr. Robert Griffiths, who led the comparative effectiveness and cost analysis said, “compared to a lot of other drugs prescribed, rituximab really is good value for money in this patient population; it’s not going to result in a lot of cost savings, but it’s still good value for money in this clinical context.”

Dr. Griffiths, of Outcomes Insights, a company that specializing in the analysis of biomedical data, also said his team was “happy to see that clinically, rituximab is working as well in routine clinical practice as it did in the trials, it’s working as well in much older patients than were included in the trials and those with a lot of comorbidity and those who get rituximab with other agents that weren’t included in the trials.”

Part of the motivation behind this analysis, Dr. Griffiths explained, was to see if it works as well in the real world as it did in clinical trials. The other motivation was the cost impact.

He and his colleagues note in their paper, online May 30 in Cancer, that a study published in Cancer in 2005 projected a net cost impact of $12,374 over 6 years of adding rituximab to standard CHOP in patients with DLBCL, which equated to cost savings of $4491 because of lower salvage and end-of-life care. But those projections were based on computer models that used data from multiple sources.

The current analysis, in contrast, used a single data source – the National Cancer Institute SEER cancer registry linked to Medicare – that reflects routine clinical practice in elderly patients. They identified 5484 elderly patients (mean age 76 years) diagnosed with DLBCL between 1999 and 2005, with claims through 2007. The patients began chemotherapy (most often CHOP) with or without rituximab within six months of diagnosis. Forty-three percent had stage III or IV disease and 64% received rituximab.

In multivariate survival analysis, rituximab was associated with significantly lower all-cause mortality at four years (hazard ratio 0.68). This was true in patients younger and older than age 80. The cumulative incremental survival associated with rituximab was 0.37 years after four years.

In the multivariate cost analysis, rituximab was associated with higher four-year total costs ($23,097), immunochemotherapy costs ($12,069), other cancer costs ($7655) and non-cancer costs ($3461).

On the basis of the multivariate survival and cost analysis, the cost per life-year gained by adding rituximab to standard chemotherapy was $62,424 ($23,097 of 0.37 life-years) over the four-year time horizon, the authors report.

“Although these findings confirm the clinical benefits of rituximab, they suggest that it may not be realistic to expect effective new cancer therapies to attenuate the rising costs of cancer care in routine clinical practice, especially for populations in which multiple comorbidities are common,” the authors say.

Dr. Griffiths added in an interview with Reuters Health, “The costs of care, particularly cancer care are out of control and people have said that drugs that save lives, prolong life are going to result in savings, but it turns out that that’s not really the case because you still have to manage all of the comorbidities. It’s a nice problem to have, but it’s not going to solve the big picture problems.”

The authors say their analysis had no specific source of funding. Three authors are employed by Outcomes Insights, Inc. and the company has received funding from Amgen and Genentech to conduct research in NHL, including on rituximab.


Comparative effectiveness and cost of adding rituximab to first-line chemotherapy for elderly patients diagnosed with diffuse large B-cell lymphoma

Cancer 2012.