Monoclonal antibody therapy has proven to be expensive, and, therefore, it is important to compare the cost-efficacy of a drug such as rituximab(Drug information on rituximab) with other standard therapies for low-grade lymphoma. Two abstracts presented at the 1998 ASH meeting (Sweetenham et al: Blood 92:415a [abstract 1715], 1998; McLaughlin et al: Blood 92:414a [abstract 1712], 1998) independently suggested that rituximab may be a more cost-effective approach than CHOP, fludarabine, or cladribine(Drug information on cladribine) (Leustatin).
At the 1999 ASH meeting, Omnes et al (abstract #420) presented a retrospective analysis of data collected in France comparing CHOP (N = 21), rituximab (N = 50), and fludarabine (N = 28) in the treatment of relapsed, low-grade NHL. Surprisingly, 62% of patients given CHOP and 48% of those given fludarabine were treated as inpatients, for reasons that were not explained.
Rituximab was associated with fewer drug-related reactions requiring hospitalization and, therefore, was considered to be more cost-effective.
However, based on the small size of this analysis, the fact that only hematologic toxicities were considered, and the fact that neither of these chemotherapeutic agents should require inpatient administration, the generalizability of these results is questionable.
Bruce D. Cheson, MD