Pharmacoeconomic Analysis of R-DA-EPOCH and R-mNHL-BFM-90 Combination Immunochemotherapy in Patients with Prognostically Unfavorable Diffuse Large B-Cell Lymphoma within Randomized Multi-Center Clinical Trial DLBCL-2015

Aim. Pharmacoeconomic analysis of R-DA-EPOCH and R-mNHL-BFM-90 combination immunochemotherapy in patients with prognostically unfavorable diffuse large B-cell lymphoma within randomized multi-center clinical trial DLB-CL-2015. Materials & Methods. The pharmacoeconomic analysis conducted between September 2018 and February 2020 was based on the treatment data of 22 patients enrolled in the DLBCL-2015 randomized multi-center clinical trial. This paper deals with the estimation of treatment outcomes in only one center, i.e., the National Research Center for Hematology. The R-DA-EPOCH induction therapy was administered to 14 out of 22 patients, 8 patients received the R-mN-HL-BFM-90 block treatment. Within the R-DA-EPOCH group the second-line therapy was administered subsequently to 5 (36 %) out of 14 patients with partial remission or disease progression. The R-mNHL-BFM-90 treatment resulted in no need to assign second-line regimens. At the first stage, the efficacy of the compared induction therapy regimens was assessed. The next stage of the pharmacoeconomic study sought to analyze only the direct medical costs associated with the whole chemotherapy process. Further, the cost-effectiveness analysis was carried out, which allowed to estimate the financial resources necessary to achieve 1 case of complete remission (CR). A pharmacoeconomic decision-tree model was developed. Results. CR was achieved in all 8 patients (100 %) who received the R-mNHL-BFM-90 block treatment. In the R-DA-EPOCH group CR was achieved only in 9 (64 %) out of 14 patients. The total mean cost of achieving 1 CR case per patient at all stages of diagnosis and chemotherapy with account for bed turnover (induction, second-line therapy, total supportive care) using R-mNHL-BFM-90 was 1,640,757 rubles, whereas in the R-DA-EPOCH group it was 1,469,878 rubles per patient. However, cumulative treatment costs of R-DA-EPOCH including chemotherapy of the second and further lines and supportive care were 2,896,519 rubles which exceeded those in the R-mNHL-BFM-90 group. Due to its higher efficacy the R-mNHL-BFM-90 immunochemotherapy precludes additional costs associated with both chemotherapy of the second and further lines and supportive care. Conclusion. R-mNHL-BFM-90 as intensive induction block immunochemotherapy for DLBCL patients with poor prognosis is more effective than R-DA-EPOCH and allows to considerably reduce cumulative costs. It is possible due to complete preclusion of the costs of second-line chemotherapy and supportive care including blood component transfusions.