Bortezomib plus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (VR-CAP) may be a more cost-effective treatment option in the United Kingdom for patients with previously untreated mantle cell lymphoma (MCL) than the current standard of care regimen including rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP).
MCL is a rare form of non-Hodgkin’s lymphoma, comprising only ~5% of all non-Hodgkin’s lymphoma cases. However, the disease is often highly aggressive and can spread quickly to other regions of the body, including the lymph nodes, spleen, bone marrow, and blood. Bortezomib was recently approved for use in patients with previously untreated MCL, for whom haematopoietic stem cell transplantation is unsuitable.
-----
Related Content
Ibrutinib a new standard of care for relapsed mantle-cell lymphoma?
Early Trials Show Promising Results for Lymphoma Immunotherapy Drug
----
In a study published in BioMed Central, researchers led by Marjolijn van Keep, BSc, MSc, BresMed, The Netherlands, used a lifetime economic model to compare the cost effectiveness of VR-CAP and R-CHOP. The model was created using health states based on line of treatment and progression status, which were taken from the LYM-3002 trial and literature. Because overall survival data were immature, survival was modeled using progression status, and post-progression survival was assumed equal across both treatment arms.
Overall, VR-CAP was found to be a more cost-effective option than R-CHOP, evidenced by an incremental quality-adjusted life year gain of 0.81 at an additional cost of £16,212, resulting in a base incremental cost-effectiveness ratio (ICER) of £20,043. When overall survival data were used directly to model cost effectiveness, the ICER increased slightly to £21,357, which authors said might suggest a continued benefit of VR-CAP over R-CHOP after disease progression in this scenario.
Deterministic and probabilistic sensitivity analyses also showed that VR-CAP was cost effective at conventional UK willingness-to-pay thresholds of £20,000–£30,000 per QALY.
Thus, researchers concluded that VR-CAP may be a cost-effective treatment option for untreated patients with MCL compared with the current standard, R-CHOP. Both the National Institute for Health and Care Excellence and Scottish Medicines Consortium recommend VR-CAP use in this patient population.
