Analisi costi-efficacia di 90Y-ibritumomab tiuxetano (Zevalin®) vs. terapie attualmente disponibili nel trattamento dei pazienti affetti da Linfoma Non-Hodgkin (LNH) refrattario o recidivato

Abstract

The aim of the paper is to compare Italian healthcare-related costs and effectiveness of 90Y-ibritumomab tiuxetan (Zevalin®) vs. currently available II and III line therapies (chemotherapy; radiotherapy; stem cell transplant) for relapsing or refractory Non-Hodgkin Lymphoma (NHL). A cost-effectiveness analysis was performed from Italian National Healthcare Service (INHS) perspective. Clinical, epidemiological and healthcare-related resource consumption data were collected from four independent sources: three clinical databases created in Canada, The Netherlands and United Kingdom (currently available III line therapies) and one published clinical trial (90Y-ibritumomab tiuxetan); further inpatient and outpatient healthcare-related resource consumption data were provided by a Dutch costing study. Inpatient and outpatient healthcare-related procedures were evaluated according to INHS tariffs, provided that 90Y-ibritumomab tiuxetan was administered in day-hospital setting. Whenever not included in INHS tariffs, drugs were mainly costed according to Italian National Therapeutic Formulary. Costs are expressed in euro 2005. Per patient cost for 90Y-ibritumomab tiuxetan equals 17,424.84 euro, whereas the average per patient cost for currently available II and III line therapies reaches 6,870.93 euro (95% CI: 533.67-13,208.19 euro). As far as effectiveness is concerned, 90Y-ibritumomab tiuxetan performs better than currently available II and III line therapies both in terms of average and median therapy-free survival (+ 0.34 years and + 0.38 years, respectively); both the differences reach statistical significance (p<0.01). The incremental cost-effectiveness ratio shows that each incremental therapy-free year of life saved with 90Y-ibritumomab tiuxetan costs 27,834.49 euro. This amount falls well within the reference cut-off range (12,000 euro-60,000 euro) and value (US$ 50,000) for year of life saved. Sensitivity analysis confirmed the robustness of basecase results. When compared to currently available III line therapies for relapsing or refractory NHL, 90Y-ibritumomab tiuxetan is cost-effective from INHS perspective. However, following some European experiences, a peculiar scheme for financing 90Yibritumomab tiuxetan as well as other innovative high-cost drugs should be early considered by INHS. Results should be confirmed via an empirical health economic study carried out within a sample of INHS oncohaematology facilities.