Follicular lymphoma (FL) is the most common type of indolent lymphoma, accounting for about 1 in 5 lymphomas in the United States. Patients with FL can have a long survival of about two decades, but they usually experience multiple relapses, along with poorer responses to treatments and lower quality of life. 

An analysis of two treatment strategies for follicular lymphoma, conducted by researchers at Georgia Institute of Technology and Winship Cancer Institute of Emory University, indicates that the treatments are cost-effective. The team included Turgay Ayer, ISyE assistant professor, Qiushi Chen, operations research graduate student at ISyE, Loretta J. Nastoupil MD, Christopher R. Flowers, MD, MS, and Adam C. Rose, MD, of the Department of Hematology and Medical Oncology and the Winship Cancer Institute at Emory University.

The researchers looked at maintenance therapy with rituximab (MR) versus observation, and radioimmunotherapy consolidation (RIT) versus observation, immediately following the first-line treatment for FL.  Clinical research has established that these treatment strategies can effectively extend the duration of remission after the first-line treatment and help patients maintain good quality of life. Given the current costs of therapy for individuals with FL of about $20,000-$36,000 per patient per year, it is also important for physicians and policy makers to understand whether the additional costs of MR and RIT are worth their clinical benefits.

The main results of the study indicate that both MR and RIT are cost-effective strategies, at an additional cost of about $40,000 per additional quality-adjusted life-year, given that a threshold of $50,000 to $100,000 has been commonly used to justify cost-effective health intervention programs in health economics studies.

The researchers concluded that MR and RIT following frontline FL therapy demonstrate favorable and similar cost-effectiveness. These findings support the coverage and use of both approaches in clinical practice, although RIT has been less commonly used. The researchers remarked that these findings do not imply a gold standard for selection of either approach or observation, and the treatment strategy for an individual with FL needs to be tailored based on individual characteristics and risk for each patient.

The full study, Comparing the Cost-Effectiveness of Rituximab Maintenance and Radioimmunotherapy Consolidation versus Observation Following First-Line Therapy in Patients with Follicular Lymphoma, is published in Value in Health.