OBJECTIVES: To assess the cost-effectiveness of obinutuzumab plus bendamustine followed by obinutuzumab maintenance therapy (O-B-O) in Chinese patients with relapse and refractory follicular lymphoma (rrFL) from the perspectives of health care payers

METHODS: A decision analytic model was constructed with Markov model to simulate lifetime health benefits and direct medical costs associated with O-B-O and the conventional therapies [bendamustine, rituximab plus bendamustine (BR), rituximab plus lenalidomide and followed by lenalidomide maintenance therapy (R2), rituximab monotherapy, and lenalidomide monotherapy in Chinese patients with rrFL. Literature evidence and a cross-sectional patient survey were the data sources for model inputs. Discounting rate was set 5% per year. Base case analysis and sensitivity analysis were conducted for point estimations and uncertainty of incremental cost-effectiveness ratio (ICER) per gained quality-adjusted life years (QALY) for O-B-O relative to the selected conventional therapy. Three times of 2021 China gross domestic products per capita (GDPPC) per gained QALY was set as the cost-effectiveness threshold.

RESULTS: Base case cost-effectiveness analyses indicated that O-B-O was associated with dominant (over R2 and lenalidomide) or attractive cost-effectiveness [over bendamustine (ICER: ¥76,393 or 0.943 GDPPC), BR (ICER: ¥37,929 or 0.468 GDPPC), and rituximab monotherapy (ICER: ¥88,133 or 1.088 GDPPC) in Chinese patients with rrFL. One-way sensitivity analyses suggested that the cost-effectiveness of O-B-O was mainly driven by survival outcomes, quality of life associated with progression-free survival, and the direct medical costs related to subsequent treatments for progressive disease. The cost-effectiveness proportions of O-B-O relative to the selected conventional therapy under the cost-effectiveness threshold ranged from 56.7% to 100.0%.

CONCLUSIONS: Using O-B-O to treat patients with rrFL was highly cost-effective when compared to the conventional therapies from the perspectives of health care payers in China.