Combination chemotherapy, such as CHOP (cyclophosphamide, doxorubicin(Drug information on doxorubicin) HCl, Oncovin, and prednisone(Drug information on prednisone)), or purine analogs, such as fludarabine (Fludara), are commonly used in the treatment of alkylating agentresistant, relapsed, low-grade B-cell non-Hodgkins lymphoma (NHL). Response rates of around 50% are seen, with median remission duration of 6 to 9 months.
The chimeric anti-CD20 monoclonal antibody, rituximab(Drug information on rituximab) (Rituxan), produces comparable response rates and response duration. Toxicity is largely infusion-related. A retrospective cost-minimization analysis from the perspective of the UK National Health Service was performed comparing the use of CHOP, fludarabine, and rituximab.PATIENTS AND METHODS: Retrospective, questionnaire-based data were collected on patients receiving CHOP (N = 48) and fludarabine (N = 50). For rituximab, data were derived from a recently completed phase II study in the UK (N = 64). Methods of administration (inpatient vs outpatient), antiemetic and antimicrobial prophylaxis, etc., and incidence and management of adverse events were collected. Drug costs were calculated from the British National Formulary (March 1998). Resource unit cost data for inpatient and outpatient visits, intensive care utilization, and diagnostic tests was obtained from Southampton University Hospitals NHS Trust. RESULTS:
CONCLUSION: The costs of rituximab use for relapsed low-grade B-cell NHL appear comparable with CHOP and lower than fludarabine, since the higher drug costs are offset by low treatment-related toxicity. These preliminary data require confirmation in a prospective, randomized trial incorporating a cost-effectiveness analysis