OBJECTIVES: Despite the curative intent of treatments in first line DLBCL, there is an unmet medical need for patients with an IPI score of three and above. We aim to demonstrate the cost-effectiveness of Polatuzumab (Pola) + Rituximab combined with Cyclophosphamide, Doxorubicin and Prednisone (R-CHP) against Rituximab combined with Cyclophosphamide, Doxorubicin, Vincristine and Prednisone (R-CHOP) in the treatment of IPI 3-5 1L DLBCL patients based on the Phase III GO39942 trial (RCT; POLARIX; NCT03274492). The relevant patient population for this new intervention for the application in Norwegian clinical practice will be identified.

METHODS: A cost-effectiveness analysis was conducted using a cure-mixture modeling approach, to compare the relative efficacy of Pola + R-CHP in comparison to R-CHOP in high risk IPI 3-5 1L DLBCL patients based on the POLARIX trial results. Norwegian clinical treatment guidelines and practices for 1L DLBCL will be reviewed and put into context.

RESULTS: In Norway, high risk IPI 3-5 patients currently treated with R-CHOP have a higher unmet medical need. Treatment of this patient group with Pola + R-CHP when compared to R-CHOP resulted in an estimated incremental cost-utility ratio of 168,171 NOK per QALY gained with incremental QALYs and LYs gained of 0.83 and 0.85 respectively based on list prices (AUP ex VAT).

CONCLUSIONS: There is a high unmet medical need in 1L DLBCL patients with IPI 3-5. The health economic analysis suggests that treatment with Pola + R-CHP in this patient population represents a cost-effective use of Norwegian health care resources at list-price.