Cost-Effectiveness Analysis of Polatuzumab Vedotin Combined with Chemoimmunotherapy in Untreated Diffuse Large B-Cell Lymphoma (DLBCL) in China

OBJECTIVES: Though conventional treatment regimens like R-CHOP are wildly used in DLBCL clinical practice, there are unmet needs remained. Polatuzumab vedotin (pola), the first-in-class ADC drug, has launched in China in 2023. The aim of the study is to evaluate the cost-effectiveness of pola-R-CHP (pola combined with rituximab, cyclophosphamide, doxorubicin, and prednisone) compared to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) for untreated DLBCL patients from the perspective of China’s healthcare system.

METHODS: A three health state partitioned survival model was performed including progression-free survival, post-progression, and death. Patients were modeled with one-week cycles over, for a lifetime horizon. Progression rates and survival outcomes were extrapolated from the Asia subpopulation of POLARIX trial based on parametric distributions fitted to survival curves, according to AIC/BIC and the visual judgment. The utility values were sourced from published literature. Medical resource utilizations and costs were estimated by experienced clinicians via in-depth interviews. Patients were designated cured if they did not progress by 5 years. Health and cost outcomes were discounted 5% annually. Outcome measures were reported in incremental cost-effectiveness ratios (ICERs). Both one-way and probabilistic sensitivity analyses were conducted.

RESULTS: The log-normal distributions were selected for PFS and OS curves in both two arms. Compared to R-CHOP, pola-R-CHP has overall 138,045 RMB incremental costs. The cost increase mainly reflected on drugs expenditure, while brought 83,388 savings on subsequent therapy. The efficacy analysis shows that pola-R-CHP is associated with an incremental gain of 2.24 life-years and 2.04 quality adjusted life-years. The incremental cost-effectiveness ratio (ICER) is lower than per capita GDP in China. Additionally, one-way and probabilistic sensitivity analyses showed that the findings were robust.

CONCLUSIONS: Pola-R-CHP is cost-effective versus R-CHOP for the treatment of untreated DLBCL in China. This cost–effectiveness was robust in sensitivity analyses.