Cost-Effectiveness of Pixantrone for the Third-/Fourth-Line Treatment of Aggressive Non-Hodgkin’s Lymphoma in Portugal

Non-Hodgkin lymphoma (NHL) decreases patients’ quality of life and is associated with considerable health resource utilization and costs. Between 1975 and 2010, the worldwide incidence of NHL has increased by 89.5%. Concerning treatment, approximately 30% of the patients will need third-/fourth-line treatment; currently there are no recommended therapeutic options for these patients. This study aimed to assess the cost-effectiveness of pixantrone for third-/fourth-line treatment of aggressive NHL in Portugal. A discrete-time Markov-type model was developed to represent NHL evolution, considering a lifetime time horizon. Ifosfamide was set as comparator to reflect national clinical practice. Efficacy and safety data were extracted from the phase III, multicentre, open-label, randomised trial NCT00088530. Parametric survival analyses were performed and best fitting models selected using Akaike's Information Criterion. Costs were retrieved from public sources. A 5%/year discount rate was adopted. Results were expressed in incremental costs per life year (LY). On average, pixantrone is expected to increase NHL patients’ LY by 11.9 months relative to ifosfamide (26.0 versus 14.1 months). Pixantrone treatment was associated with discounted incremental costs of 27,373€ mainly related to higher drug costs and higher patients’ life expectancy, corresponding to an incremental cost-effectiveness ratio (ICER) of 38,550€/LY. The sensitivity analysis performed both for costs and effectiveness parameters revealed low variation in results, with LY and ICER ranging between 0.70-0.71 and 34,060-39,610€/LY, respectively. Pixantrone is expected to increase NHL patients’ life expectancy and to be associated with commonly acceptable incremental costs per life year gained.