The Economic Impact of Polatuzumab Vedotin as First-Line Therapy for High-Risk DLBCL on Subsequent Treatments Within the Italian National Health Service

OBJECTIVES: To assess the financial consequences on subsequent treatments following the introduction of polatuzumab vedotin combined with rituximab and chemotherapy (Pola-RCHP) as first-line treatment of Diffuse Large B-Cell Lymphoma (DLBCL) patients with an International Prognostic Index (IPI) score of 3-5 within the context of the Italian National Health-Care Service (NHS).

METHODS: Subsequent anti-lymphoma treatment data of the intention-to-treat (ITT) IPI 3-5 subgroup population were extracted from the POLARIX study. The data included distributions and the average number of subsequent systemic treatments received after standard therapy with rituximab and chemotherapy (R-CHOP) and Pola-RCHP. Annual proportions of patients initiating subsequent lines of treatment over a 3-year time horizon were estimated using a partitioned survival model with three mutually exclusive health states simulating disease evolution with a mixture cure rate model. The costs per progression event were determined by the frequency and type of subsequent therapies received, including autologous stem cell transplant (ASCT), salvage therapies, immunochemotherapy, and CAR-T cell therapy. All costs were evaluated from the perspective of Italian NHS.

RESULTS: Patients receiving Pola-RCHP were less likely to require subsequent therapy than patients receiving R-CHOP (2.26 vs 3.13, respectively), with an estimated average cost savings of €12.2K per patient in the first year. Over a 3-year time horizon, approximately 5,000 patients with an IPI score of 3-5 are expected to initiate systemic treatment for DLBCL, with more than 70% receiving Pola-RCHP. Pola-RCHP is projected to reduce the number of subsequent treatments by approximately 1,800, resulting in an estimated total cost savings of around 60 million euros for the Italian NHS.

CONCLUSIONS: The reduction in subsequent treatments may potentially mitigate the initial higher expenditure associated with the use of Pola-RCHP instead of R-CHOP in the first-line treatment for high-risk DLBCL patients. This can lead to a significant cost decrease in the subsequent anti-lymphoma treatments for the Italian NHS.