Exploring the potential cost-effectiveness of precision medicine treatment strategies for diffuse large B-cell lymphoma

Qiushi Chen, Ashley D. Staton, Turgay Ayer, Daniel A. Goldstein, Jean L. Koff, Christopher R. Flowers

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Activated B-cell-like (ABC) diffuse large B-cell lymphoma (DLBCL) is associated with worse survival after standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) chemoimmunotherapy compared to germinal center B-cell-like (GCB) subtype. Preliminary evidence suggests that benefits from novel agents may vary by subtype. Hypothesizing that treatment stratified by DLBCL subtype could be potentially cost-effective, we developed micro-simulation models to compare three first-line treatment strategies: (1) standard RCHOP for all patients (2) subtype testing followed by RCHOP for GCB and novel treatment for ABC DLBCL, and (3) novel treatment for all patients. Based on phase 2 evidence, we used lenalidomide + RCHOP as a surrogate novel treatment. The subtype-based approach showed a favorable incremental cost-effectiveness ratio of $15,015/quality-adjusted life year compared with RCHOP. Although our exploratory analyses demonstrated a wide range of conditions where subtype-based treatment remained cost-effective, data from phase 3 trials are needed to validate our models’ findings and draw definitive conclusions.

Original languageEnglish (US)
Pages (from-to)1700-1709
Number of pages10
JournalLeukemia and Lymphoma
Volume59
Issue number7
DOIs
StatePublished - Jul 3 2018

Fingerprint

Precision Medicine
Lymphoma, Large B-Cell, Diffuse
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide
Cost-Benefit Analysis
B-Lymphocytes
Germinal Center
Therapeutics
Quality-Adjusted Life Years
Health Care Costs
Rituximab
Costs and Cost Analysis
Survival

All Science Journal Classification (ASJC) codes

  • Hematology
  • Oncology
  • Cancer Research

Cite this

Chen, Qiushi ; Staton, Ashley D. ; Ayer, Turgay ; Goldstein, Daniel A. ; Koff, Jean L. ; Flowers, Christopher R. / Exploring the potential cost-effectiveness of precision medicine treatment strategies for diffuse large B-cell lymphoma. In: Leukemia and Lymphoma. 2018 ; Vol. 59, No. 7. pp. 1700-1709.
@article{a288a8a07b924663b9c50da2c40bb42c,
title = "Exploring the potential cost-effectiveness of precision medicine treatment strategies for diffuse large B-cell lymphoma",
abstract = "Activated B-cell-like (ABC) diffuse large B-cell lymphoma (DLBCL) is associated with worse survival after standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) chemoimmunotherapy compared to germinal center B-cell-like (GCB) subtype. Preliminary evidence suggests that benefits from novel agents may vary by subtype. Hypothesizing that treatment stratified by DLBCL subtype could be potentially cost-effective, we developed micro-simulation models to compare three first-line treatment strategies: (1) standard RCHOP for all patients (2) subtype testing followed by RCHOP for GCB and novel treatment for ABC DLBCL, and (3) novel treatment for all patients. Based on phase 2 evidence, we used lenalidomide + RCHOP as a surrogate novel treatment. The subtype-based approach showed a favorable incremental cost-effectiveness ratio of $15,015/quality-adjusted life year compared with RCHOP. Although our exploratory analyses demonstrated a wide range of conditions where subtype-based treatment remained cost-effective, data from phase 3 trials are needed to validate our models’ findings and draw definitive conclusions.",
author = "Qiushi Chen and Staton, {Ashley D.} and Turgay Ayer and Goldstein, {Daniel A.} and Koff, {Jean L.} and Flowers, {Christopher R.}",
year = "2018",
month = "7",
day = "3",
doi = "10.1080/10428194.2017.1390230",
language = "English (US)",
volume = "59",
pages = "1700--1709",
journal = "Leukemia and Lymphoma",
issn = "1042-8194",
publisher = "Informa Healthcare",
number = "7",

}

Exploring the potential cost-effectiveness of precision medicine treatment strategies for diffuse large B-cell lymphoma. / Chen, Qiushi; Staton, Ashley D.; Ayer, Turgay; Goldstein, Daniel A.; Koff, Jean L.; Flowers, Christopher R.

In: Leukemia and Lymphoma, Vol. 59, No. 7, 03.07.2018, p. 1700-1709.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Exploring the potential cost-effectiveness of precision medicine treatment strategies for diffuse large B-cell lymphoma

AU - Chen, Qiushi

AU - Staton, Ashley D.

AU - Ayer, Turgay

AU - Goldstein, Daniel A.

AU - Koff, Jean L.

AU - Flowers, Christopher R.

PY - 2018/7/3

Y1 - 2018/7/3

N2 - Activated B-cell-like (ABC) diffuse large B-cell lymphoma (DLBCL) is associated with worse survival after standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) chemoimmunotherapy compared to germinal center B-cell-like (GCB) subtype. Preliminary evidence suggests that benefits from novel agents may vary by subtype. Hypothesizing that treatment stratified by DLBCL subtype could be potentially cost-effective, we developed micro-simulation models to compare three first-line treatment strategies: (1) standard RCHOP for all patients (2) subtype testing followed by RCHOP for GCB and novel treatment for ABC DLBCL, and (3) novel treatment for all patients. Based on phase 2 evidence, we used lenalidomide + RCHOP as a surrogate novel treatment. The subtype-based approach showed a favorable incremental cost-effectiveness ratio of $15,015/quality-adjusted life year compared with RCHOP. Although our exploratory analyses demonstrated a wide range of conditions where subtype-based treatment remained cost-effective, data from phase 3 trials are needed to validate our models’ findings and draw definitive conclusions.

AB - Activated B-cell-like (ABC) diffuse large B-cell lymphoma (DLBCL) is associated with worse survival after standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) chemoimmunotherapy compared to germinal center B-cell-like (GCB) subtype. Preliminary evidence suggests that benefits from novel agents may vary by subtype. Hypothesizing that treatment stratified by DLBCL subtype could be potentially cost-effective, we developed micro-simulation models to compare three first-line treatment strategies: (1) standard RCHOP for all patients (2) subtype testing followed by RCHOP for GCB and novel treatment for ABC DLBCL, and (3) novel treatment for all patients. Based on phase 2 evidence, we used lenalidomide + RCHOP as a surrogate novel treatment. The subtype-based approach showed a favorable incremental cost-effectiveness ratio of $15,015/quality-adjusted life year compared with RCHOP. Although our exploratory analyses demonstrated a wide range of conditions where subtype-based treatment remained cost-effective, data from phase 3 trials are needed to validate our models’ findings and draw definitive conclusions.

UR - http://www.scopus.com/inward/record.url?scp=85032213084&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032213084&partnerID=8YFLogxK

U2 - 10.1080/10428194.2017.1390230

DO - 10.1080/10428194.2017.1390230

M3 - Article

C2 - 29065744

AN - SCOPUS:85032213084

VL - 59

SP - 1700

EP - 1709

JO - Leukemia and Lymphoma

JF - Leukemia and Lymphoma

SN - 1042-8194

IS - 7

ER -