Purpose: Today, patients with relapsed low-grade or follicular B-cell non-Hodgkin lymphoma have more treatment options available to them than ever. These therapies include infused chemotherapy regimens, radioimmunotherapy, and oral agents. There is limited information available about the impact of available treatment sequences on clinical outcomes and costs.
Methods: A budget impact model was developed to represent the current treatment pathways for relapsed low-grade or follicular B-cell non-Hodgkin lymphoma. First-line treatment regimens were selected based on the Category 1 recommendations from the National Comprehensive Cancer Network guidelines for follicular lymphoma. Those included were the most commonly used: BR, RCHOP, and RCVP. For purposes of this model, the second-line regimens included Y90 ibritumomab (Y90), rituximab monotherapy with 4 weekly doses, and idelalisib. Treatment outcomes were based on the published literature that summarized the overall response rate, median duration of response (DOR), and toxicity. Total costs per treatment regimen were based on medical care, drugs administered, and associated adverse effects. The 2015 Medicare fee schedule rates were used to estimate the medical care costs. Total DOR and costs were determined for each treatment regimen.
Results: The treatment sequence, BR followed by Y90 at the time of relapse, had the longest predicted DOR (7.2 years). The associated treatment sequence costs were $157,712 for BR followed by Y90, compared with $224,628 and $145,047 for BR followed by idelalisib and BR followed by rituximab monotherapy, respectively, with a predicted DOR of 6.7 years. The predicted DOR for treatment sequences starting with RCVP and RCHOP and followed by Y90 was about 3 years less than BR followed by Y90 at a cost increase of $11,102 and $37,866, respectively. The use of idelalisib after RCVP or RCHOP had a predicted DOR of 3.6 years, respectively, with associated costs that were greater than BR followed by Y90.
Conclusions: The use of Y90 ibritumomab after BR demonstrated the optimal patient outcomes at one of the lowest cost profiles.
