A Novel View on the Treatment Costs of Relapsed or Refractory Diffuse Large B-cell Lymphoma From the Brazilian Private Healthcare System Perspective: A First- to Third-Line Analysis
Author(s)
Frederico Sallum, MSc, Livia Maria Gonçalves Barbosa, PharmD, Camila Burnett, LLB.
Knight Therapeutics, São Paulo, Brazil.
Knight Therapeutics, São Paulo, Brazil.
OBJECTIVES: To analyze the treatment cost of relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) in transplant-ineligible patients within Brazilian private healthcare system from the second-line treatment to the third at a time horizon of 15 months considering the first-line therapy duration.
METHODS: RCHOP was considered the first-line standard. For second-line options, three regimens were included: R-GemOx; Pola-BR; tafasitamab plus lenalidomide. Epcoritamab was included as the third-line treatment. Three treatment sequences were analyzed: 1) RCHOP, tafasitamab plus lenalidomide, epcoritamab; 2) RCHOP, Pola-BR, epcoritamab; 3) RCHOP, R-GemOx, epcoritamab. Three clinical scenarios were defined based on time in RCHOP per NCCN guidelines. Median treatment durations guided the time in second-line therapy, and the remaining months completed the 15-month horizon in the third line. Treatment costs were calculated from the CMED drug price list assuming a patient weight of 73.5 kilograms.
RESULTS: Scenario #1: relapsed (6 months RCHOP): Sequence 1: 9-month tafasitamab plus lenalidomide: 710,333 BRL. Sequence 2: 5-month Pola-BR + 4-month epcoritamab: 1,126,324 BRL. Sequence 3: 4-month R-GemOx + 5-month epcoritamab: 908,546 BRL. Scenario #2: refractory (5-month RCHOP): Sequence 1: 9-month tafasitamab plus lenalidomide + 1-month epcoritamab: 836,661 BRL. Sequence 2: 5-month Pola-BR + 5-month epcoritamab: 1,242,934 BRL. Sequence 3: 4-month R-GemOx + 6-month epcoritamab: 1,025,156 BRL. Scenario #3: primary refractory (4-month RCHOP): Sequence 1: 9-month tafasitamab plus lenalidomide + 2-month epcoritamab: 1,069,882 BRL. Sequence 2: 5-month Pola-BR + 6-month epcoritamab: 1,359,545 BRL. Sequence 3: 4-month R-GemOx + 7-month epcoritamab: 1,141,767 BRL.
CONCLUSIONS: The use of tafasitamab plus lenalidomide as second-line therapy leads to cost reductions of 58.6%, 48.6%, and 27.1% relative to Pola-BR, and 27.9%, 22.5%, and 6.7% relative to R-GemOx, for relapsed, refractory, and primary refractory patients, respectively. This study underscores the importance of evaluating treatment costs across first to third lines of therapy in the R/R DLBCL treatment.
METHODS: RCHOP was considered the first-line standard. For second-line options, three regimens were included: R-GemOx; Pola-BR; tafasitamab plus lenalidomide. Epcoritamab was included as the third-line treatment. Three treatment sequences were analyzed: 1) RCHOP, tafasitamab plus lenalidomide, epcoritamab; 2) RCHOP, Pola-BR, epcoritamab; 3) RCHOP, R-GemOx, epcoritamab. Three clinical scenarios were defined based on time in RCHOP per NCCN guidelines. Median treatment durations guided the time in second-line therapy, and the remaining months completed the 15-month horizon in the third line. Treatment costs were calculated from the CMED drug price list assuming a patient weight of 73.5 kilograms.
RESULTS: Scenario #1: relapsed (6 months RCHOP): Sequence 1: 9-month tafasitamab plus lenalidomide: 710,333 BRL. Sequence 2: 5-month Pola-BR + 4-month epcoritamab: 1,126,324 BRL. Sequence 3: 4-month R-GemOx + 5-month epcoritamab: 908,546 BRL. Scenario #2: refractory (5-month RCHOP): Sequence 1: 9-month tafasitamab plus lenalidomide + 1-month epcoritamab: 836,661 BRL. Sequence 2: 5-month Pola-BR + 5-month epcoritamab: 1,242,934 BRL. Sequence 3: 4-month R-GemOx + 6-month epcoritamab: 1,025,156 BRL. Scenario #3: primary refractory (4-month RCHOP): Sequence 1: 9-month tafasitamab plus lenalidomide + 2-month epcoritamab: 1,069,882 BRL. Sequence 2: 5-month Pola-BR + 6-month epcoritamab: 1,359,545 BRL. Sequence 3: 4-month R-GemOx + 7-month epcoritamab: 1,141,767 BRL.
CONCLUSIONS: The use of tafasitamab plus lenalidomide as second-line therapy leads to cost reductions of 58.6%, 48.6%, and 27.1% relative to Pola-BR, and 27.9%, 22.5%, and 6.7% relative to R-GemOx, for relapsed, refractory, and primary refractory patients, respectively. This study underscores the importance of evaluating treatment costs across first to third lines of therapy in the R/R DLBCL treatment.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE25
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
Oncology