Non-Hodgkin lymphoma: retrospective study on the cost-effectiveness of early treatment response assessment by FDG-PET

Abstract

Purpose

Although lymphomas are very chemosensitive, 50% of patients with aggressive non-Hodgkin lymphoma (NHL) are not cured with standard first-line treatment. This consists of six cycles of doxorubicin, vincristine, prednisolone and cyclophosphamide (CHOP), recently complemented with rituximab. Preliminary studies show that PET mid-treatment is a good predictor of the remission status at the end of therapy. As patients with persistent FDG uptake after three cycles are unlikely to gain a complete remission, the remaining three cycles of chemotherapy are useless. We investigated the costs and benefits for the use of PET in this early treatment setting.

Methods

We conceived a model using a conventional arm where patients receive the full regimen of six cycles of CHOP [-rituximab (R)] and an experimental algorithm where patients receive either six cycles (PET response) or only three cycles (PET non-response). Based on a patient sample (2004–2006), we calculated the costs for hospitalisation and treatment. We took into account all costs accrued (including overhead costs). We used a sensitivity analysis by varying the most important parameters.

Results

With a PET price of 700€ and CHOP price (per cycle) of 1,829€, we can conclude to cost saving of 1,879€ per patient. The PET price can increase up to 2,580€ and the cost for one cycle of CHOP can decrease to 500€ per cycle before cost savings are nil. The percentage of non-responders may be as low as 10%. The implementation of rituximab in first-line therapy only increases benefit (4,900€/pt).

Conclusion

We conclude to substantial cost savings if management of NHL patients is based on mid-treatment PET scan. The economical data we used seem to be comparable to those published in other European studies. Implementation of Mabthera in first line only increases cost savings.