Background: Maintenance therapy with rituximab for follicular lymphoma (FL) responding to induction at the first-line, significantly increases progression-free survival compared with observation. To estimate the efficiency of this therapeutic option, we performed a cost-effectiveness analysis of maintenance therapy of the follicular lymphoma (FL) that responds to induction in first line, with rituximab, compared with the option of "watch and wait" strategy.
Methods: We did a Markov model of the FL, with four health states (progression free survival in first or second line, progression and death). The transition probabilities between states were obtained from clinical trials PRIMA and EORTC 20981. Health state utilities were obtained from literature. The use of health resources, from the perspective of the National Health System was estimated by a panel of Spanish clinical experts. Unit costs (euros in 2011) were obtained from Spanish sources. Deterministic and probabilistic analyses were made.
Results: In the deterministic base case analysis, for a time horizon of 30 years, the cost per life year gained (LYG) and quality-adjusted life-years (QALYs) gained, was euros 5,663 and euros 6,253 respectively. The sensitivity analyses confirmed the stability of the base case for time horizons of 10 and 20 years and various statistical distributions (Weibull, exponential, log-logistic, log-normal, Gompertz, and gamma) ranging between euros 4,222 and euros 8,766. Rituximab maintenance is cost-effective from a time horizon of 5.7 years (cost per QALY gained of euros 29,998).
Conclusion: Compared with observation, rituximab maintenance treatment of the FL that responds to induction therapy in first line, is cost-effective according to the present model.