Cost-effectiveness of extended adjuvant rituximab for US patients aged 65-70 years with follicular lymphoma in second remission

Purpose: A recent Intergroup trial showed that receiving adjuvant rituximab after having a second remission from follicular lymphoma (FL) improved progression-free and overall survival (OS). The current study was conducted to determine the incremental cost-effectiveness ratio of this strategy in the United States. Patients and Methods: We constructed a transition state model to estimate the incremental cost-effectiveness ratio of extended adjuvant rituximab for 2 years for patients having a second FL remission. Event-free and OS rates were estimated from the recently published Intergroup trial. These were adjusted to reflect the contribution of non-cancer-specific mortality for patients aged 65-70 years, a more commonly affected age group than in the Intergroup trial, which had a median age of 54 years. Previously reported quality of life and cost estimates were obtained from peer-reviewed sources. Results: Five years after a second induction with R-CHOP (rituximab with cyclophosphamide/doxorubicin/vincristine/prednisone), disease-free survival is expected to be 47% and 22%, and the OS rates are estimated to be 73% and 61% for extended adjuvant rituximab and observation, respectively, during the second remission. The discounted incremental cost-effectiveness ratio for the addition of adjuvant rituximab is estimated to be $19,522 per quality-adjusted life-years gained. Conclusion: Extended adjuvant rituximab offers a clinical benefit to patients aged 65-70 years who have a second remission from FL at a cost generally acceptable to the US healthcare system.