Long-term data needed to determine cost efficacy of new DLBCL treatments
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NEW ORLEANS — Cost efficacy of polatuzumab vedotin added to traditional treatments for diffuse large B-cell lymphoma in the front-line requires long-term PFS data, according to a poster presented at ASH Annual Meeting and Exhibition.
“After 2 years of follow up, the pola-R-CHP regimen [polatuzumab vedotin (Polivy, Genentech), rituximab (Rituxan; Genentech, Biogen), cyclophosphamide, doxorubicin, prednisolone] regimen has been shown to be superior in prolonging progression-free survival,” Yu-Hua Fu, from the Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University in Taipei, said during her virtual poster presentation. “However, it remains unknown whether the lower rate of treatment failure with pola-R-CHP can be translated into reduced subsequent health care costs, increased life years and improved quality of life.”
Fu and colleagues designed a model in which they projected lifetime quality-adjusted life years (QALYs) gained, life years gained and direct health care costs in patients with newly diagnosed DLBCL when treated with either pola-R-CHP or R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisolone). They adjusted costs to 2021 U.S. dollars and calculated incremental cost-effectiveness ratios (ICERs). They considered a willingness-to-pay threshold of $150,000 per QALY gained as the acceptable level to determine cost effectiveness.
In the base case scenario of continued treatment effect for 2 years, Fu showed that pola-R-CHP conferred a 0.64 life years benefit over R-CHOP (10.64 vs. 10) and 0.48 QALY benefit (8.76 vs. 8.28). The cost, however, was $98,314 more, with pola-R-CHP estimated to cost $217,514. The ICER, therefore, was $204,945, putting it beyond the willingness-to-pay threshold. The researchers based this effect duration on the POLARIX trial, which Fu noted had a relatively short follow-up period.
Fu showed that this effect is highly sensitive to patient age and the price of pola. In this scenario, only 30% of cases would fall under the threshold.
However, when Fu and colleagues extended treatment effect to a duration of 5 years, the QALY benefit increased to 0.89 (7.15 for R-CHOP vs. 8.04 for pola-R-CHP). The average cost difference lowered to $90,439 and the ICER dropped to $101,510.
“Our study suggested that the ICER of pola-R-CHP compared [with] the standard R-CHOP regimen was highly sensitive to long-term survival benefits provided by pola,” Fu said. “Mature survival data would be required to fully evaluate the value of pola in treating newly diagnosed DLBCL.”
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Fu Y, et al. Poster 4854. Presented at: ASH Annual Meeting and Exposition; Dec. 10-13, 2022; New Orleans.
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