TY - JOUR
T1 - Impact on medical cost, cumulative survival, and cost-effectiveness of adding rituximab to first-line chemotherapy for follicular lymphoma in elderly patients
T2 - An observational cohort study based on SEER-medicare
AU - Griffiths, Robert I.
AU - Gleeson, Michelle L.
AU - Mikhael, Joseph
AU - Danese, Mark D.
PY - 2012
Y1 - 2012
N2 - Rituximab improves survival in follicular lymphoma (FL), but is considerably more expensive than conventional chemotherapy. We estimated the total direct medical costs, cumulative survival, and cost-effectiveness of adding rituximab to first-line chemotherapy for FL, based on a single source of data representing routine practice in the elderly. Using surveillance, epidemiology, and end results (SEER) registry data plus Medicare claims, we identified 1,117 FL patients who received first-line CHOP (cyclophosphamide (C), doxorubicin, vincristine (V), and prednisone (P)) or CVP +/- rituximab. Multivariate regression was used to estimate adjusted cumulative cost and survival differences between the two groups over four years after beginning treatment. The median age was 73 years (minimum 66 years), 56% had stage III-IV disease, and 67% received rituximab. Adding rituximab to first-line chemotherapy was associated with higher adjusted incremental total cost ($18,695; 95% Confidence Interval (CI) $9,302$28,643) and longer adjusted cumulative survival (0.18 years; 95% CI 0.100.27) over four years of followup. The expected cost-effectiveness was $102,142 (95% CI $34,531296, 337) per life-year gained. In routine clinical practice, adding rituximab to first-line chemotherapy for elderly patients with FL results in higher direct medical costs to Medicare and longer cumulative survival after four years.
AB - Rituximab improves survival in follicular lymphoma (FL), but is considerably more expensive than conventional chemotherapy. We estimated the total direct medical costs, cumulative survival, and cost-effectiveness of adding rituximab to first-line chemotherapy for FL, based on a single source of data representing routine practice in the elderly. Using surveillance, epidemiology, and end results (SEER) registry data plus Medicare claims, we identified 1,117 FL patients who received first-line CHOP (cyclophosphamide (C), doxorubicin, vincristine (V), and prednisone (P)) or CVP +/- rituximab. Multivariate regression was used to estimate adjusted cumulative cost and survival differences between the two groups over four years after beginning treatment. The median age was 73 years (minimum 66 years), 56% had stage III-IV disease, and 67% received rituximab. Adding rituximab to first-line chemotherapy was associated with higher adjusted incremental total cost ($18,695; 95% Confidence Interval (CI) $9,302$28,643) and longer adjusted cumulative survival (0.18 years; 95% CI 0.100.27) over four years of followup. The expected cost-effectiveness was $102,142 (95% CI $34,531296, 337) per life-year gained. In routine clinical practice, adding rituximab to first-line chemotherapy for elderly patients with FL results in higher direct medical costs to Medicare and longer cumulative survival after four years.
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U2 - 10.1155/2012/978391
DO - 10.1155/2012/978391
M3 - Article
C2 - 22969803
AN - SCOPUS:84866245288
SN - 1687-8558
JO - Journal of Cancer Epidemiology
JF - Journal of Cancer Epidemiology
M1 - 978391
ER -