BACKGROUND: Since 1995 patients with relapsed aggressive non-Hodgkin lymphoma have been treated with high-dose chemotherapy (HDC) instead of standard dose chemotherapy (SC) because of superior survival shown in the 'Parma study'. As HDC involves hospital admission and intensive supportive care, the cost of HDC would be predicted to be higher than for SC. The aim of this study was to calculate the incremental cost-effectiveness ratio for HDC compared with SC using Australian costs. METHODS: Cost of treatment was determined on 21 patients receiving HDC with characteristics similar to the Parma study from the HDC database of the Calvary Mater Newcastle Hospital. Drug, transfusion, inpatient and outpatient attendance and additional relevant data from start of treatment for relapse and up to 100 days following HDC were obtained and costed. SC costs required modelling as all suitable patients are planned to receive HDC if possible; therefore there are no concurrent SC arms. A lifetime estimate of patient years gained by HDC versus SC was calculated from the area under survival curves (AUC) of HDC and SC. The incremental cost-effectiveness ratio was calculated according to the following formula: RESULTS: Costs for HDC and SC were A$37 490 and A$33 360, respectively, and the AUC(0-infinity) were 4.09 and 3.5 patient life years, respectively, giving an incremental cost-effectiveness ratio of A$7070 per discounted life year gained. CONCLUSION: Compared with published studies in multiple myeloma and solid organ transplant, these results support HDC as a cost-effective treatment in relapsed aggressive non-Hodgkin lymphoma.

Item Type:	Refereed Article
Keywords:	Bone marrow transplant; Cost-effectiveness; Incremental cost-effectiveness ratio; Non-Hodgkin lymphoma; Peripheral blood stem-cell transplant
Research Division:	Economics
Research Group:	Applied Economics
Research Field:	Health Economics
Objective Division:	Health
Objective Group:	Health and Support Services
Objective Field:	Health Policy Economic Outcomes
Author:	Neil, A (Dr Amanda Neil)
ID Code:	93293
Year Published:	2009
Web of Science® Times Cited:	1
Deposited By:	Menzies Institute for Medical Research
Deposited On:	2014-07-24
Last Modified:	2014-10-10
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