Cost Analysis of Polatuzumab Vedotin in Combination With Rituximab Cyclophosphamide Doxorubicin and Prednisone in the Treatment of Adult Patients With Previously Untreated Diffuse Large B-cell Lymphoma in Portugal
Author(s)
Bernardete Pinheiro, MSc1, Ana Salomé Correia, PhD1, Pedro Carvalho, MSc1, Daniela Alves, MD2, Herlander Marques, MD, PhD3, José Mário Mariz, MD4, Marília Gomes, MD5, Rodrigo Ho, PharmD6, Aino Launonen, MSc6, Catarina Pereira, MSc7, Margarida Borges, MD1.
1IQVIA Portugal, Porto Salvo - Oeiras, Portugal, 2Unidade Local de Saúde Santa Maria, Lisboa, Portugal, 3Unidade Local de Saúde de Braga, Braga, Portugal, 4Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Porto, Portugal, 5Unidade Local de Saúde de Coimbra, Coimbra, Portugal, 6F. Hoffmann-La Roche Ltd, Basel, Switzerland, 7Roche Farmacêutica Química, Lda, Amadora, Portugal.
1IQVIA Portugal, Porto Salvo - Oeiras, Portugal, 2Unidade Local de Saúde Santa Maria, Lisboa, Portugal, 3Unidade Local de Saúde de Braga, Braga, Portugal, 4Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Porto, Portugal, 5Unidade Local de Saúde de Coimbra, Coimbra, Portugal, 6F. Hoffmann-La Roche Ltd, Basel, Switzerland, 7Roche Farmacêutica Química, Lda, Amadora, Portugal.
OBJECTIVES: To evaluate the potential clinical and economic impact of polatuzumab vedotin combined with rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP) versus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for treating untreated adults with Diffuse Large B-Cell Lymphoma (DLBCL) in Portugal.
METHODS: A partitioned survival model was developed to assess the cost-effectiveness of polatuzumab + R-CHP versus R-CHOP for previously untreated adults with DLBCL in Portugal. The model considered three health states: progression-free survival (PFS), post-progression survival (PPS), and death. Clinical data were obtained from the POLARIX trial (polatuzumab’s pivotal trial in this therapeutic indication) and supplemented with external matched R-CHOP PFS data from the finalized GOYA trial. The modelling approach combines Kaplan-Meier estimates and a mixture-cure model for extrapolation. Portuguese-specific disease management resource use was based on an expert panel and Portuguese diagnosis-related group microdata. The main sources for unit costs were national legislation and official drug cost databases. The analysis was conducted from the National Health Service perspective, assuming a lifetime horizon and a 4% discount rate, according to Portuguese guidelines. The model was considered valid for reimbursement decision-making within the Portuguese setting.
RESULTS: Treatment with polatuzumab increases average life expectancy by 0.18 discounted life years (LY), increasing the PFS in 0.92 LY and reducing the time in PPS in 0.74 LY. This is primarily due to the higher cure fraction of polatuzumab compared to R-CHOP (73% versus 64%). Although associated with higher total costs (30,365 €), economic analysis reveals cost savings in managing progressive disease states (reduction of 15,274 €), with lower subsequent therapy costs, reduced PPS follow-up costs, and decreased end-of-life costs.
CONCLUSIONS: Compared to R-CHOP, treatment with polatuzumab leads to increased progression-free survival. While polatuzumab involves higher costs during the progression-free stage, it contributes to cost savings in the post-progression stage.
METHODS: A partitioned survival model was developed to assess the cost-effectiveness of polatuzumab + R-CHP versus R-CHOP for previously untreated adults with DLBCL in Portugal. The model considered three health states: progression-free survival (PFS), post-progression survival (PPS), and death. Clinical data were obtained from the POLARIX trial (polatuzumab’s pivotal trial in this therapeutic indication) and supplemented with external matched R-CHOP PFS data from the finalized GOYA trial. The modelling approach combines Kaplan-Meier estimates and a mixture-cure model for extrapolation. Portuguese-specific disease management resource use was based on an expert panel and Portuguese diagnosis-related group microdata. The main sources for unit costs were national legislation and official drug cost databases. The analysis was conducted from the National Health Service perspective, assuming a lifetime horizon and a 4% discount rate, according to Portuguese guidelines. The model was considered valid for reimbursement decision-making within the Portuguese setting.
RESULTS: Treatment with polatuzumab increases average life expectancy by 0.18 discounted life years (LY), increasing the PFS in 0.92 LY and reducing the time in PPS in 0.74 LY. This is primarily due to the higher cure fraction of polatuzumab compared to R-CHOP (73% versus 64%). Although associated with higher total costs (30,365 €), economic analysis reveals cost savings in managing progressive disease states (reduction of 15,274 €), with lower subsequent therapy costs, reduced PPS follow-up costs, and decreased end-of-life costs.
CONCLUSIONS: Compared to R-CHOP, treatment with polatuzumab leads to increased progression-free survival. While polatuzumab involves higher costs during the progression-free stage, it contributes to cost savings in the post-progression stage.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE155
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology