Modelling cost-effectiveness of high-dose chemotherapy as treatment for relapsed aggressive non-Hodgkin lymphoma in an Australian setting

Since 1995 patients with relapsed aggressive non-Hodgkin lymphoma have been treated with high-dose chemotherapy (HDC) instead of standard dose chemotherapy (SC) because of superior survival shown in the ‘Parma study’. As HDC involves hospital admission and intensive supportive care, the cost of HDC would be predicted to be higher than for SC. The aim of this study was to calculate the incremental cost-effectiveness ratio for HDC compared with SC using Australian costs. Cost of treatment was determined on 21 patients receiving HDC with characteristics similar to the Parma study from the HDC database of the Calvary Mater Newcastle Hospital. Drug, transfusion, inpatient and outpatient attendance and additional relevant data from start of treatment for relapse and up to 100 days following HDC were obtained and costed. SC costs required modelling as all suitable patients are planned to receive HDC if possible; therefore there are no concurrent SC arms. A lifetime estimate of patient years gained by HDC versus SC was calculated from the area under survival curves (AUC) of HDC and SC. The incremental cost-effectiveness ratio was calculated according to the following formula: Incremental Cost/Incremental Benefit = (CostsHᴅᴄ-CostsSᴅᴄ)/(AUCHᴅᴄ-AUCSᴅᴄ). Costs for HDC and SC were A$37 490 and A$33 360, respectively, and the AUC0-infinity were 4.09 and 3.5 patient life years, respectively, giving an incremental cost-effectiveness ratio of A$7070 per discounted life year gained. Compared with published studies in multiple myeloma and solid organ transplant, these results support HDC as a cost-effective treatment in relapsed aggressive non-Hodgkin lymphoma