SOUTHAMPTON, UKNew immunotherapeutic agents often come with big
price tags, but the costs of treating relapsed non-Hodgkins
lymphoma (NHL) with a new anti-CD20 monoclonal antibody may be lower
than the costs of conventional therapy, according to an economic
analysis by UK researchers. This was because the antibody (rituximab,
Rituxan) caused fewer side effects and thus had lower costs related
to adverse events, John Sweetenham, MD, reported at an ASH poster session.
Dr. Sweetenham and his colleagues at the University of South-ampton
compared the cost of treating relapsed low-grade B cell NHL with CHOP
(cyclophosphamide, doxorubicin, vincristine, prednisone); fludarabine
(Fludara); or rituximab therapy.
They performed a retrospective cost-minimization analysis of the
three regimens using data from the British National Health Service
and from a phase II UK trial of rituximab. The study included data on
48 patients receiving CHOP, 50 receiving fludarabine, and 64 on rituximab.
Data collected included methods of administration (inpatient vs
outpatient), antiemetic and antimicrobial prophylaxis, diagnostic
tests, intensive care unit visits, and incidence and management of
Response Rates Similar
Dr. Sweetenham reported that patients given CHOP had a response rate
of 45% and a median time to progression of 6 months. [Fludarabine
produces similar results.] This was comparable to the 48% response
rate and 13 month time to relapse with rituximab.
However, the number of adverse events was much greater with a single
cycle of CHOP or fludarabine than with a full course of rituximab (Figure
1). Rituximab toxicity is largely infusion related, mostly with
the first infusion. Only 17 rituximab patients had infusion-related
toxicity requiring hospital admission.
This reduced toxicity translated into a significant savings in both
the cost of treating adverse events and the total cost of treatment
(see Figure 2).
The biggest contributor to the cost of CHOP chemotherapy is
toxicity, he said. The biggest contributor to the cost of
rituximab therapy is the cost of the drug. The total cost of
rituximab and CHOP therapy came out fairly close (£6,080
vs £7,209) because the higher cost
of rituximab was offset by the lower toxicity.
Fludarabine therapy had the highest total cost because it is more
toxic than rituximab and is a more expensive drug than rituximab or
CHOP. In this context, Dr. Sweetenham said,
rituximab is useful because it has efficacy equal to other
treatments and can easily be administered in an outpatient setting.