Abstract

Current standard second-line regimens for the treatment of non-Hodgkin’s lymphoma (NHL) are administered over a period of 3–6 months, generating substantial treatment costs. In Switzerland, Yttrium-90 (90Y)-ibritumomab tiuxetan was introduced in 2004 as the first-in-class radioimmunotherapy for the treatment of relapsed or refractory indolent NHL. It is delivered in an outpatient setting over a period of 8 days. In Switzerland, just as in the United States, assessment of the biodistribution of the antibody is required one week prior to the actual treatment (this step is not required in the European Union). This analysis compared the costs of 90Y-ibritumomab tiuxetan with 8 cycles of rituximab (R), 6 or 8 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone), and 6 or 8 cycles of R-CVP (rituximab, cyclophosphamide, vincristine, prednisolone), respectively. Direct medical treatment costs and costs of absence from work (indirect costs) were included. For each treatment option, the number of cycles per treatment and the total medical resources used to care for the patient throughout the treatment were assessed for a theoretical standard patient, defined as 60 years old with therapy refractory, grade 1–2, stage III-IV NHL. The resources used were valued with unit costs or prices gained from the Swiss national fee schedule for medical services, lists of administered prices for laboratory tests and pharmaceuticals, and purchasing prices for all other relevant items. Total lost productivity due to absence from work was estimated by multiplying the days absent from work with average income per day. Results are summarized in Table 1. Direct treatment costs for 90Y-ibritumomab tiuxetan were lower than 8 x R, 8 x R-CHOP, and 8 x R-CVP but higher than 6 x R-CHOP or 6 x R-CVP. When indirect costs were taken into account, total 90Y-ibritumomab tiuxetan cost was lower than for all other regimens except 6 x R-CVP. The only sensitivity analysis that changed the ranking of the treatment options was omitting the biodistribution study and thus adopting the EU regimen for 90Y-ibritumomab tiuxetan. This reduced the costs of radioimmunotherapy to CHF 27,766. In conclusion, 90Y-ibritumomab tiuxetan is not more expensive than other established treatments for relapsed or refractory indolent NHL. Table 1. Per-patient costs by treatment in Switzerland.

Costs (CHF)
Treatment optionDirectIndirectTotal
6 x R-CVP 34,045 3,794 37,839 
90Y-ibritumomab tiuxetan 38,619 1,265 39,884 
6 x R-CHOP 36,711 5,691 42,403 
8 x R 42,625 2,024 44,649 
8 x R-CVP 44,878 5,059 49,937 
8 x R-CHOP 48,250 7,589 55,839 
Costs (CHF)
Treatment optionDirectIndirectTotal
6 x R-CVP 34,045 3,794 37,839 
90Y-ibritumomab tiuxetan 38,619 1,265 39,884 
6 x R-CHOP 36,711 5,691 42,403 
8 x R 42,625 2,024 44,649 
8 x R-CVP 44,878 5,059 49,937 
8 x R-CHOP 48,250 7,589 55,839 

Author notes

Disclosure:Consultancy: Felicitas Hitz: Advisory board for Bayer Schering Pharma AG. Research Funding: Andreas Frei: Research funding from Bayer Schering Pharma AG; Matthias Schwenkglenks: Research funding from Bayer Schering Pharma AG.