Costs of Rituximab Treatment Lower Than Fludarabine or CHOP

SOUTHAMPTON, UK—New immunotherapeutic agents often come with big price tags, but the costs of treating relapsed non-Hodgkin’s lymphoma (NHL) with a new anti-CD20 monoclonal antibody may be lower than the costs of conventional therapy, according to an economic analysis by UK researchers. This was because the antibody (rituximab, Rituxan) caused fewer side effects and thus had lower costs related to adverse events, John Sweetenham, MD, reported at an ASH poster session.

Dr. Sweetenham and his colleagues at the University of South-ampton compared the cost of treating relapsed low-grade B cell NHL with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone); fludarabine (Fludara); or rituximab therapy.

They performed a retrospective cost-minimization analysis of the three regimens using data from the British National Health Service and from a phase II UK trial of rituximab. The study included data on 48 patients receiving CHOP, 50 receiving fludarabine, and 64 on rituximab.

Data collected included methods of administration (inpatient vs outpatient), antiemetic and antimicrobial prophylaxis, diagnostic tests, intensive care unit visits, and incidence and management of adverse events.

Response Rates Similar

Dr. Sweetenham reported that patients given CHOP had a response rate of 45% and a median time to progression of 6 months. [Fludarabine produces similar results.] This was comparable to the 48% response rate and 13 month time to relapse with rituximab.

However, the number of adverse events was much greater with a single cycle of CHOP or fludarabine than with a full course of rituximab (Figure 1). Rituximab toxicity is largely infusion related, mostly with the first infusion. Only 17 rituximab patients had infusion-related toxicity requiring hospital admission.

This reduced toxicity translated into a significant savings in both the cost of treating adverse events and the total cost of treatment (see Figure 2).

“The biggest contributor to the cost of CHOP chemotherapy is toxicity,” he said. “The biggest contributor to the cost of rituximab therapy is the cost of the drug. The total cost of rituximab and CHOP therapy came out fairly close (£6,080 vs £7,209) because the higher cost of rituximab was offset by the lower toxicity.”

Fludarabine therapy had the highest total cost because it is more toxic than rituximab and is a more expensive drug than rituximab or CHOP. “In this context,” Dr. Sweetenham said, “rituximab is useful because it has efficacy equal to other treatments and can easily be administered in an outpatient setting.”