OBJECTIVES: To evaluate the cost effectiveness (CE) of obinutuzumab+bendamustine in the treatment of relapsed/refractory follicular lymphoma (FL) compared to bendamustine alone in Turkey.

METHODS: The CE model evaluates the CE of obinutuzumab+bendamustine for the treatment of patients with FL who did not respond or who progressed during or up to 6 months after rituximab or a rituximab-containing regimen. Patient outcomes are simulated using a 3-state area under the curve model including progression-free survival (PFS), progressive disease and death. The study is undertaken from perspective of the Turkish healthcare payer as Social Security Institution (SSI). Obinutuzumab+bendamustine is compared directly through GADOLIN trial with bendamustine. Drug utilization and adverse events are based on trial data and country specific data is implemented for the Turkish healthcare setting. The cost data is obtained from several SSI Health Implementation Notification lists. Cycle length of the model was 1 month. Health benefits and costs were measured over 25 years and discounted at an annual rate of 3,5%. Sensitivity analyses were conducted to assess model uncertainty and 5.000 simulations were run for validation.

RESULTS: The incremental cost-effectiveness ratio (ICER) falls under the willingness-to-pay threshold which is 3 times the GDP per capita of Turkey, ~170.000TRY. The main driver of these results are the treatment effect of obinutuzumab+bendamustine in terms of projected OS benefit, time horizon and duration of treatment. The ICER is 76.427TRY per QALY gained and 61.476TRY per LYG. Based on probabilistic sensitivity analysis (PSA), ICER is 77.476TRY per QALY and 62.855TRY per LYG. This indicates a solid clinical contribution of obinutuzumab for relapsed/refractory follicular lymphoma patients.

CONCLUSIONS: Obinutuzumab+bendamustine treatment is cost-effective in the relapsed/refractory FL compared to bendamustine alone in Turkey.