Cost-Effectiveness of Lenalidomide Plus Rituximab Versus Rituximab Monotherapy in Patients with Previously Treated Follicular Lymphoma

Abstract Background: Efficacy of lenalidomide plus rituximab (R-LEN) compared to rituximab monotherapy (R-mono) for patients with previously treated follicular lymphoma (FL) was investigated in AUGMENT (NCT01938001). Our aim was to evaluate the cost-effectiveness of R-LEN versus R-mono in this setting from a Dutch perspective.Methods: Cost-effectiveness was assessed through a partitioned survival model with three health states from three perspectives (i.e. societal, healthcare and societal including future non-medical costs). Patient-level data from AUGMENT informed effectiveness parameters (i.e. long-term survival) and health state utilities. Resource use and prices were based on AUGMENT and the literature. Clinical experts validated efficacy input parameters and results. Uncertainty was explored through sensitivity and scenario analyses.Results: R-LEN resulted in 1.7 incremental discounted QALYs. Total incremental discounted costs were 67,161 EUR from a societal perspective, resulting in an incremental cost-effectiveness ratio (ICER) of 40,493 EUR/QALY (healthcare: 37,951 EUR/QALY; societal including future non-medical costs: 49,296 EUR/QALY). Sensitivity analyses indicated some uncertainty in the model results. In some scenarios R-LEN exceed an ICER of 50,000 EUR/QALY.Conclusion: R-LEN was cost-effective at a willingness-to-pay (WTP) threshold of 50,000 EUR/QALY in the base-case analyses. Scenario and sensitivity analyses indicated some level of uncertainty regarding this conclusion, depending on the chosen WTP-threshold and perspective.