ISPOR 19th Annual European Congress
Vienna, Austria
October, 2016
Hematological Disorders
Cost Studies (CS)
Cost-Effectiveness Analysis (CE)
Critchlow S1, Lee D1, Latour A2, Wildgust M3, Goldberg J4, Rule S5, Wang M6
1BresMed Health Solutions, Sheffield, UK, 2Janssen-Cilag Ltd, High Wycombe, UK, 3Janssen Research & Development, LLC, Raritan, NJ, USA, 4Janssen Pharmaceutical Research & Development, Raritan, NJ, USA, 5Plymouth University School of Medicine and Dentistry, Plymouth, UK, 6The University of Texas MD Anderson Cancer Center, Houston, TX, USA
OBJECTIVES: Given the paucity of evidence available to inform the effectiveness of rituximab-based (R)-chemotherapy regimens in relapsed/refractory mantle cell lymphoma (R/R MCL), we present two methods that enable comparison between the health outcomes of ibrutinib and R-chemotherapy in R/R MCL. METHODS: Data from three ibrutinib clinical trials were pooled to create a larger, more mature dataset. Data for R-chemotherapy consisted only of small studies not reporting enough information to allow comparison. A 3-state cost-utility model with a 15-year time horizon compared the two treatments using two methods: 1) a hazard ratio (HR) was obtained from an indirect treatment comparison (ITC) between the ibrutinib MCL3001 trial1 and published monotherapy chemotherapy evidence2, using temsirolimus as the common comparator. The effect of rituximab was added by applying a further HR based on observational data3. 2) Temsirolimus was used as a proxy for R-chemotherapy based on MCL3001 data. Progression-free survival (PFS) was extrapolated from the ibrutinib pooled dataset and the HR described above was applied to the R-chemotherapy arm. Given the limited R-chemotherapy evidence and the immaturity of the available ibrutinib overall survival (OS) data, post-progression survival (PPS) was assumed equal in the two arms. OS was the sum of PFS + PPS. Utility data were taken from the pooled ibrutinib dataset and a utility decrement for patients while receiving chemotherapy was applied as per expert opinion4. RESULTS: Estimated outcomes for ibrutinib were 2.28 life years (LYs) and 1.59 QALYs per patient. R-chemotherapy resulted in 1.04 LYs and 0.65 QALYs using the fist method and 1.26 LYs and 0.77 QALYs using the second method. CONCLUSIONS: The limited evidence available in R/R MCL inhibits a direct comparison between ibrutinib and R-chemotherapy. Modelled estimates using available data indicate that ibrutinib offers a large QALY and LY benefit versus R-chemotherapy.