• Johanes Prajogo, Amanda Neil, Janine Duke, Hong Zhang, Barrie Stokes, and Philip Rowlings.
• Centre for Clinical Epidemiology and Biostatistics, the University of Newcastle;
• Intern Med J. 2009 Jun 10.

AbstractBackground: Since 1995 patients with relapsed aggressive non Hodgkin's lymphoma (NHL) have been treated with high dose chemotherapy (HDC) instead of standard dose chemotherapy (SC) because of superior survival demonstrated 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 (ICER) for HDC compared to SC using Australian costs. Methods: Cost of treatment was determined on 21 pts receiving HDC with characteristics similar to the Parma study from the HDC database of the Calvary Mater Newcastle Hospital (CMNH). 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 pts are planned to receive HDC if possible, therefore no concurrent SC arms exist. 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 ICER was calculated according to formula: Incremental Cost / Incremental Benefit = (Costs(HDC)-Costs(SDC)) / (AUC(HDC)-AUC(SDC)). Results: Cost for HDC and SC were $AU37,490 and $AU33,360 respectively, and the AUC(0-infinity) were 4.09 and 3.5 patient life years respectively giving an ICER of $AU7,070 per discounted life year gained. Conclusion Compared to published studies in multiple myeloma and solid organ transplant these results support HDC as a cost-effective treatment in relapsed aggressive NHL.

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