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Economic evaluation of obinutuzumab in combination with chlorambucil in first-line treatment of patients with chronic lymphocytic leukemia in Spain

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To evaluate the cost-effectiveness of obinutuzumab in combination with chlorambucil (GClb) versus rituximab plus chlorambucil (RClb) in the treatment of adults with previously untreated chronic lymphocytic leukemia (CLL) and with comorbidities that make them unsuitable for full-dose fludarabine-based therapy, from the perspective of the Spanish National Health System.

Methods: A Markov model was developed with three mutually exclusive health states: progression-free survival (with or without treatment), progression, and death. Survival time for the two treatments was modeled based on the results of CLL11 clinical trial and external sources. Each health state was associated with a utility value and direct medical costs. The utilities were obtained from a utility elicitation study conducted in the UK. Costs and general background mortality data were obtained from published Spanish sources. Deterministic and probabilistic analyses were conducted, with a time frame of 20 years. The health outcomes were measured as life years (LYs) gained and quality-adjusted life years (QALYs) gained. Efficiency was measured as the cost per LY or per QALY gained of the most effective regimen.

Results: In the deterministic base case analysis, each patient treated with GClb resulted in 0.717 LYs gained and 0.673 QALYs gained versus RClb. The cost per LY and per QALY gained with GClb versus RClb was €23,314 and €24,838, respectively. The results proved stable in most of the univariate and probabilistic sensitivity analyses, with a probabilistic cost per QALY gained of €24,734 (95% confidence interval: €21,860–28,367).

Conclusion: Using GClb to treat patients with previously untreated CLL for whom full-dose fludarabine-based therapy is unsuitable allows significant gains in terms of LYs and QALYs versus treatment with RClb. Treatment with GClb versus RClb can be regarded as efficient when considered the willingness to pay thresholds commonly used in Spain.

No MeSH data available.


Cost-effectiveness plane (cost per QALY gained with GClb vs RClb).Notes: Each point represents the ICER of each of the 1,000 simulations performed, comparing the new alternative (GClb) versus standard treatment (RClb).Abbreviations: GClb, obinutuzumab + chlorambucil; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; RClb, rituximab + chlorambucil.
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f3-ceor-8-475: Cost-effectiveness plane (cost per QALY gained with GClb vs RClb).Notes: Each point represents the ICER of each of the 1,000 simulations performed, comparing the new alternative (GClb) versus standard treatment (RClb).Abbreviations: GClb, obinutuzumab + chlorambucil; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; RClb, rituximab + chlorambucil.

Mentions: The probabilistic analysis confirmed the base case results. The ICER referred to GClb versus RClb was €23,192 (€19,346–28,521) per LY gained and €24,734 (€21,860–28,367) per QALY gained (Table 4). The impact of the uncertainty upon the outcome of the model is represented in the cost-effectiveness plane (Figure 3), where the 1,000 Monte Carlo simulations were run. The incremental cost-effectiveness acceptability curve (Figure 4) showed that 95% of the simulations were below €29,165 per QALY gained and 100% were below €34,432 per QALY gained.


Economic evaluation of obinutuzumab in combination with chlorambucil in first-line treatment of patients with chronic lymphocytic leukemia in Spain
Cost-effectiveness plane (cost per QALY gained with GClb vs RClb).Notes: Each point represents the ICER of each of the 1,000 simulations performed, comparing the new alternative (GClb) versus standard treatment (RClb).Abbreviations: GClb, obinutuzumab + chlorambucil; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; RClb, rituximab + chlorambucil.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5036824&req=5

f3-ceor-8-475: Cost-effectiveness plane (cost per QALY gained with GClb vs RClb).Notes: Each point represents the ICER of each of the 1,000 simulations performed, comparing the new alternative (GClb) versus standard treatment (RClb).Abbreviations: GClb, obinutuzumab + chlorambucil; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year; RClb, rituximab + chlorambucil.
Mentions: The probabilistic analysis confirmed the base case results. The ICER referred to GClb versus RClb was €23,192 (€19,346–28,521) per LY gained and €24,734 (€21,860–28,367) per QALY gained (Table 4). The impact of the uncertainty upon the outcome of the model is represented in the cost-effectiveness plane (Figure 3), where the 1,000 Monte Carlo simulations were run. The incremental cost-effectiveness acceptability curve (Figure 4) showed that 95% of the simulations were below €29,165 per QALY gained and 100% were below €34,432 per QALY gained.

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To evaluate the cost-effectiveness of obinutuzumab in combination with chlorambucil (GClb) versus rituximab plus chlorambucil (RClb) in the treatment of adults with previously untreated chronic lymphocytic leukemia (CLL) and with comorbidities that make them unsuitable for full-dose fludarabine-based therapy, from the perspective of the Spanish National Health System.

Methods: A Markov model was developed with three mutually exclusive health states: progression-free survival (with or without treatment), progression, and death. Survival time for the two treatments was modeled based on the results of CLL11 clinical trial and external sources. Each health state was associated with a utility value and direct medical costs. The utilities were obtained from a utility elicitation study conducted in the UK. Costs and general background mortality data were obtained from published Spanish sources. Deterministic and probabilistic analyses were conducted, with a time frame of 20 years. The health outcomes were measured as life years (LYs) gained and quality-adjusted life years (QALYs) gained. Efficiency was measured as the cost per LY or per QALY gained of the most effective regimen.

Results: In the deterministic base case analysis, each patient treated with GClb resulted in 0.717 LYs gained and 0.673 QALYs gained versus RClb. The cost per LY and per QALY gained with GClb versus RClb was €23,314 and €24,838, respectively. The results proved stable in most of the univariate and probabilistic sensitivity analyses, with a probabilistic cost per QALY gained of €24,734 (95% confidence interval: €21,860–28,367).

Conclusion: Using GClb to treat patients with previously untreated CLL for whom full-dose fludarabine-based therapy is unsuitable allows significant gains in terms of LYs and QALYs versus treatment with RClb. Treatment with GClb versus RClb can be regarded as efficient when considered the willingness to pay thresholds commonly used in Spain.

No MeSH data available.