Cost Effectiveness of Polatuzumab Vedotin Combined with Chemoimmunotherapy in Untreated Diffuse Large B-cell Lymphoma
Menée dans un contexte américain, cette étude analyse le rapport coût-efficacité d'une chimio-immunothérapie de première ligne de type R-CHP en combinaison avec le polatuzumab védotin chez des patients atteints d'un lymphome diffus à grandes cellules B
Résumé en anglais
In patients with treatment-naive diffuse large B-cell lymphoma (DLBCL), the POLARIX study demonstrated a 6.5% improvement in the 2-year progression-free survival (PFS) with no difference in overall survival (OS) or safety using pola-R-CHP compared to standard R-CHOP. We evaluated the cost-effectiveness of pola-R-CHP for DLBCL. We modeled a hypothetical cohort of US adults (mean age, 65 years) with treatment-naïve DLBCL by developing a Markov model (lifetime horizon) to model the cost-effectiveness of pola-R-CHP and R-CHOP using a range of plausible long-term outcomes. Progression rates and OS were estimated from POLARIX. Outcome measures were reported in incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay (WTP) threshold of $150,000/quality-adjusted life-year (QALY). Assuming a 5-year PFS of 69.6% with pola-R-CHP and 62.7% with R-CHOP, pola-R-CHP was cost-effective at a WTP of 150,000 (ICER $84,308/QALY). Pola-R-CHP was no longer cost-effective if its 5-year PFS was 66.1% or lower. One-way sensitivity analysis demonstrated that pola-R-CHP is cost-effective up to a cost of $276,312 at a WTP of $150,000. Pola-R-CHP was the cost-effective strategy in 56.6% of the 10,000 Monte-Carlo iterations at a WTP of $150,000. If the absolute benefit in PFS is maintained over time, pola-R-CHP is cost-effective when compared to R-CHOP at a WTP of $150,000/QALY. However, its cost-effectiveness is highly dependent on its long-term outcomes and CAR-T cost. Routine usage of pola-R-CHP would add significantly to healthcare expenditures. Price reductions or identification of subgroups that have maximal benefit would improve cost-effectiveness.
