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Addition of Rituximab to First-Line Treatment of Burkitt Lymphoma in Children and Young Adults in Tanzania: A
Liz Morrell1,2, William F Mawalla3, Malale Tungu4
1Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Purpose:
Burkitt lymphoma (BL) is a highly prevalent childhood cancer in sub-Saharan Africa. Outcomes are poor, with only 50% 2-year survival. Improving survival through intensifying chemotherapy treatment has proved challenging. Incorporating rituximab (a high-cost biological agent) into the current chemotherapy regimen is an alternative approach. A recent observational study in Tanzania and Uganda found improved 1-year survival, with no significant additional adverse events, when rituximab was added to chemotherapy. We present an economic evaluation of this regimen compared with current treatment.
Methods:
We conducted a cost-utility analysis from a Tanzanian health care perspective, over a patient lifetime, using a 4-state Markov model. Outcomes were measured in Disability-Adjusted Life Years (DALYs), and results were compared with three possible cost-effectiveness thresholds ($411 US dollars [USD], $1,211 USD and $3,633 USD). Survival, adverse events, and chemotherapy use came from the observational study (N = 72). Other resource used was derived from treatment protocols and clinical expertise, and unit costs (2023) were provided by Tanzanian hospitals. Survival was modeled parametrically over 2 years, after which survivors were assumed to be cured. We examined heterogeneity in cost-effectiveness by disease stage and performed sensitivity and scenario analyses.
Results:
Adding rituximab gave an incremental cost-effectiveness ratio (ICER) of $483 USD per DALY averted, slightly above the most stringent of the thresholds considered, and would be considered cost effective at any threshold above $501 USD. Rituximab was particularly cost effective in advanced-stage disease (ICER $395 USD). Results were sensitive to discount rate, drug costs particularly rituximab, and disease progression assumptions. Budget impact was estimated as Tanzanian Shillings 415 billion ($160 million USD) annually, from 5 years after implementation.
Conclusion:
Adding rituximab to current chemotherapy is a plausibly cost-effective treatment that would save lives in childhood BL, particularly for advanced-stage patients.
