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Cost-effectiveness analysis alongside the inter-B-NHL ritux 2010 trial: rituximab in children and adolescents with B cell non-Hodgkin's lymphoma.

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Lueza, Béranger 
Aupérin, Anne 
Rigaud, Charlotte 
Gross, Thomas G 
Pillon, Marta 


OBJECTIVES: The randomized controlled trial Inter-B-NHL ritux 2010 showed overall survival (OS) benefit and event-free survival (EFS) benefit with the addition of rituximab to standard Lymphomes Malins B (LMB) chemotherapy in children and adolescents with high-risk, mature B cell non-Hodgkin's lymphoma. Our aim was to assess the cost-effectiveness of rituximab-chemotherapy versus chemotherapy alone in the French setting. METHODS: We used a decision-analytic semi-Markov model with four health states and 1-month cycles. Resource use was prospectively collected in the Inter-B-NHL ritux 2010 trial (NCT01516580). Transition probabilities were assessed from patient-level data from the trial (n = 328). In the base case analysis, direct medical costs from the French National Insurance Scheme and life-years (LYs) were computed in both arms over a 3-year time horizon. Incremental net monetary benefit and cost-effectiveness acceptability curve were computed through a probabilistic sensitivity analysis. Deterministic sensitivity analysis and several sensitivity analyses on key assumptions were also conducted, including one exploratory analysis with quality-adjusted life years as the health outcome. RESULTS: OS and EFS benefits shown in the Inter-B-NHL ritux 2010 trial translated into the model by rituximab-chemotherapy being the most effective and also the least expensive strategy over the chemotherapy strategy. The mean difference in LYs between arms was 0.13 [95% CI 0.02; 0.25], and the mean cost difference € - 3 710 [95% CI € - 17,877; € 10,525] in favor of rituximab-chemotherapy group. For a € 50,000 per LY willingness-to-pay threshold, the probability of the rituximab-chemotherapy strategy being cost-effective was 91.1%. All sensitivity analyses confirmed these findings. CONCLUSION: Adding rituximab to LMB chemotherapy in children and adolescents with high-risk mature B-cell non-Hodgkin's lymphoma is highly cost-effective in France. TRIAL REGISTRATION: identifier: NCT01516580.


Acknowledgements: We would like to thank Gisèle Goma and Anthony Mangin for the data management for the patients at the EICNHL sites; Muriel Wartelle for IT coordination. The authors thank Yuki Takahashi for editing.

Funder: Ministère des Affaires Sociales, de la Santé et des Droits des Femmes; doi:


Economic evaluation, High-risk B-NHL, Immunotherapy, Semi-Markov model, Child, Humans, Adolescent, Rituximab, Cost-Effectiveness Analysis, Cost-Benefit Analysis, Progression-Free Survival, Lymphoma, Non-Hodgkin, Antineoplastic Combined Chemotherapy Protocols

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Eur J Health Econ

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Springer Science and Business Media LLC