Socio-economic Benefits of Using Obinutuzumab in 1st Line Treatment of Follicular Lymphoma

Impact of FL disease on the labor market

In Germany, about 47% of FL patients are under the age of 65 and many of them are active in the labor market at the time of diagnosis. Patients with hematologic malignancies often experience work capacity limitations. Fatigue, pain, side effects of cancer treatment, and psychological burden from the diagnosis can also complicate ordinary self-care. If remission is achieved, patients' activities are restored, although not always to the same extent.

Prolongation of progression-free survival

New anticancer drugs extend the overall survival of patients or at least periods of remission or disease stabilization (measured by progression-free survival – PFS), which is the basis for patients to return to normal daily activities or work. Obinutuzumab in 1st line chemoimmunotherapy for FL extends PFS and reduces the risk of early relapse compared to standard rituximab. In the GALLIUM study, the hazard ratio (HR) for progression, relapse, or death after 3 years from the start of treatment was 0.66 (obinutuzumab vs. rituximab; 95% confidence interval [CI] 0.51–0.85; p = 0.001).

Prolongation of remission periods is not only a clinical benefit but should also reflect an increase in work productivity. People also engage in many unpaid activities (housework, childcare, caregiving, volunteering, civic associations, etc.), which also generate added value for society. The German study used a cost-effectiveness analysis methodology to focus on the impact of obinutuzumab treatment compared to rituximab on the productivity of paid and unpaid work.

Pharmacoeconomic model

The researchers used German statistical reports (e.g., the incidence of FL, employment, and time spent on housework) and analyses from other European countries (probability of returning to work and estimation of reduced work productivity after hematologic malignancy). Based on data from the GALLIUM study, they simulated the course of FL treatment and its outcome (prolongation of PFS) in an average patient and created a model for a population of 25,419 newly diagnosed German patients. The model was created for the period 2017–2030. The health benefits of obinutuzumab treatment (PFS gain) were then converted into increased productivity of paid and unpaid work, measured by gross added value. Unpaid work was assigned such financial value as it would have as a commercially available service.

Quantifying the results

This complex modeling allowed the authors to quantify the socio-economic benefits of obinutuzumab treatment. Overall, for a model population of more than 25 thousand patients, it was possible to quantify that the administration of obinutuzumab was associated with an increase of 11,870 progression-free years compared to rituximab. This led to a total gross added value of €723.8 million more compared to rituximab, with unpaid work productivity accounting for €535.9 million and paid work €187.9 million.

Conclusion and discussion

From a societal perspective, the analysis by German pharmacoeconomists showed that the benefits of using obinutuzumab in 1st line treatment of FL extend beyond medical effects. Prolongation of PFS also reflects in the patient's involvement within the family, community, and society as a whole. However, one limitation of the analysis remains that adverse effects of induction and maintenance therapy were not included in its models.

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Source: Hofmann S., Himmler S., Ostwald D. et al. The societal impact of obinutuzumab in the first-line treatment of patients with follicular lymphoma in Germany. J Comp Eff Res 2020; 9 (14): 1017–1026, doi: 10.2217/cer-2020-0131.