The use of 90 Y-ibritumomab tiuxetan (Y90-IT) in consolidation or second-line treatment of relapsed or refractory follicular lymphoma (FL) demonstrated desired patient outcomes at one of the lowest cost profiles.

“The choice of initial therapy in follicular lymphoma can be a key determinant in future therapy, as irreversible toxicities with first line regimens can impact the patient’s ability to tolerate future treatment,” wrote Ali McBride, PharmD, MS, University of Arizona Cancer Center, and Daniel Persky, MD, University of Arizona, Tucson.

“Minimizing drug exposure will result in less frequent occurrence of significant adverse events and associated treatment costs,” they added.

This study aimed to describe the impact of treatment selection and sequencing on outcomes and costs for relapsed or refractory follicular lymphoma (FL) using a budget impact model.

Key model input included number of treatment cycles, number of days a treatment was received, duration of response (DOR), rate of side effects and associated costs, and total treatment costs, including drugs, medical treatment, laboratory testing and adverse event costs.

The study included 7 first-line therapy options (bendamustine plus rituximab [BR]; bendamustine plus obinutuzumab; CHOP plus rituximab; CHOP plus obinutuzumab; CVP plus rituximab; CVP plus obinutuzumab; and lenalidomide plus rituximab), 3 consolidation options (rituximab maintenance; obinutuzumab maintenance; and radioimmunotherapy with Y90-IT) and 3 second-line therapy options (radioimmunotherapy; lenalidomide; and lenalidomide plus obinutuzumab).

The treatment sequence of first-line bendamustine plus rituximab followed by consolidation with radioimmunotherapy with Y90-IT had the longest predicted DOR (2586 days). The associated treatment sequence costs were $212,485 for BR followed by Y90-IT, compared with $233,388 for BR followed by rituximab maintenance, which had a predicted DOR of 2478 days.

Additionally, the predicted DOR for treatment sequences starting with CHOP plus obinutuzumab, CVP plus obinutuzumab and CHOP plus rituximab and followed by radioimmunotherapy with Y90-IT was approximately 1000 days less than BR followed by Y90-IT for a cost difference of $4,421, $12,914 and $25,826, respectively.

Researchers noted that the treatment sequence of first line BR followed by second-line radioimmunotherapy with Y90-IT had the second longest predicted DOR (2586 days) and costs of $212,485, compared to 2778 days for BR followed by lenalidomide plus obinutuzumab, at a total sequence costs of $796,695.

“The use of Y90-IT in Consolidation or Second Line treatment demonstrated desired patient outcomes at one of the lowest cost profiles,” concluded Dr McBride and Dr Persky.

“Additionally, Y90-IT administration can be completed in only two clinic visits, reducing patient travel and contact, improving safety in an era of COVID-19 precautionary measures and reducing cost,” they added.—Janelle Bradley

McBride A, Persky O. Impact of Treatment Sequencing on Outcomes and Costs in Relapsed Follicular or Other Low Grade B-Cell Non-Hodgkin Lymphoma – Results of an Evidence-Based Budget Impact Model. Presented at: the 62nd ASH Annual Meeting and Exposition. December 5-8, 2020. Abstract 2511.