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Economic evaluation of obinutuzumab in combination with chlorambucil in first-line treatment of patients with chronic lymphocytic leukemia in Spain

Authors Casado LF, Burgos A, González-Haba E, Loscertales J, Krivasi T, Orofino J, Rubio-Terrés C, Rubio-Rodríguez D

Received 7 June 2016

Accepted for publication 8 July 2016

Published 21 September 2016 Volume 2016:8 Pages 475—484


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Professor Giorgio Lorenzo Colombo

Luis Felipe Casado,1 Amparo Burgos,2 Eva González-Haba,3 Javier Loscertales,4 Tania Krivasi,5 Javier Orofino,6 Carlos Rubio-Terres,7 Darío Rubio-Rodríguez7

1Hematology Department, Hospital Virgen de la Salud, Toledo, Spain; 2Pharmacy Department, Hospital General Universitario de Alicante, Alicante, Spain; 3Pharmacy Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; 4Hematology Deparment, Hospital Universitario De La Princesa, Madrid, Spain; 5Hoffmann-La Roche Ltd., Basel, Switzerland; 6Roche Farma SA, Madrid, Spain; 7Health Value, Madrid, Spain

Objective: To evaluate the cost-effectiveness of obinutuzumab in combination with chlorambucil (GClb) versus rituximab plus chlorambucil (RClb) in the treatment of adults with previously untreated chronic lymphocytic leukemia (CLL) and with comorbidities that make them unsuitable for full-dose fludarabine-based therapy, from the perspective of the Spanish National Health System.
Methods: A Markov model was developed with three mutually exclusive health states: progression-free survival (with or without treatment), progression, and death. Survival time for the two treatments was modeled based on the results of CLL11 clinical trial and external sources. Each health state was associated with a utility value and direct medical costs. The utilities were obtained from a utility elicitation study conducted in the UK. Costs and general background mortality data were obtained from published Spanish sources. Deterministic and probabilistic analyses were conducted, with a time frame of 20 years. The health outcomes were measured as life years (LYs) gained and quality-adjusted life years (QALYs) gained. Efficiency was measured as the cost per LY or per QALY gained of the most effective regimen.
Results: In the deterministic base case analysis, each patient treated with GClb resulted in 0.717 LYs gained and 0.673 QALYs gained versus RClb. The cost per LY and per QALY gained with GClb versus RClb was €23,314 and €24,838, respectively. The results proved stable in most of the univariate and probabilistic sensitivity analyses, with a probabilistic cost per QALY gained of €24,734 (95% confidence interval: €21,860–28,367).
Conclusion: Using GClb to treat patients with previously untreated CLL for whom full-dose fludarabine-based therapy is unsuitable allows significant gains in terms of LYs and QALYs versus treatment with RClb. Treatment with GClb versus RClb can be regarded as efficient when considered the willingness to pay thresholds commonly used in Spain.

Keywords: chlorambucil, chronic lymphocytic leukemia, cost-effectiveness, obinutuzumab, rituximab

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