{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T17:58:53Z","timestamp":1767203933672,"version":"build-2238731810"},"reference-count":5,"publisher":"National Institute for Health and Care Research","issue":"Suppl 1","license":[{"start":{"date-parts":[[2009,6,1]],"date-time":"2009-06-01T00:00:00Z","timestamp":1243814400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["05\/55-01"],"award-info":[{"award-number":["05\/55-01"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:p>This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of rituximab for the first-line treatment of stage III\/IV follicular non-Hodgkin\u2019s lymphoma (FNHL) based upon the manufacturer\u2019s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The manufacturer\u2019s scope restricts the intervention to rituximab in combination with CVP (cyclophosphamide, vincristine and prednisolone) (R-CVP); the only comparator used was CVP alone. The evidence from the one included randomised controlled trial (RCT) suggests that the addition of rituximab to a CVP chemotherapy regimen has a positive effect on the outcomes of time to treatment failure, disease progression, overall tumour response, duration of response and time to new lymphoma treatment in patients with stage III\/IV FNHL compared with CVP alone. Adverse events were comparable between the two arms. This study was confirmed as the only relevant RCT. The economic analyses provided by the manufacturer were modelled using a three-state Markov model with with the health states being defined as progression-free survival (PFS), progressed (in which patients have relapsed) and death (which is an absorbing state). The model generated results for a cohort of patients with an initial age of 53 and makes no distinction between men and women. The model is basic in design, with several serious design flaws and key parameter values that are probably incompatible. Attempting to rectify the identified errors and limitations of the model did not increase the incremental cost-effectiveness ratio (ICER) above \u00a330,000. Although the cost-effectiveness results obtained appear to be compelling in support of R-CVP compared with CVP for the trial population the results may not be so convincing for a more representative population. The results of the ERG analysis on the impact of age suggest that ICERs increase steadily with age, as the proportion of PFS that can be converted to overall survival (OS) is diminished by rising mortality rates in the general population. For the most extreme scenario (no OS gain) the ICER appears to remain below \u00a330,000 per QALY gained. On balance the evidence indicates that R-CVP is more cost-effective than CVP. The guidance issued by NICE in July 2006 as a result of the STA states that rituximab within its licensed indication (in combination with cyclophosphamide, vincristine and prednisolone) is recommended as an option for the treatment of symptomatic stage III\/IV follicular non-Hodgkin\u2019s lymphoma in previously untreated patients.<\/jats:p>","DOI":"10.3310\/hta13suppl1-04","type":"journal-article","created":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T13:12:28Z","timestamp":1613049148000},"page":"23-28","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Rituximab for the first-line treatment of stage III\/IV follicular non-Hodgkin\u2019s lymphoma"],"prefix":"10.3310","volume":"13","author":[{"given":"Y","family":"Dundar","sequence":"first","affiliation":[{"name":"Liverpool Reviews and Implementation Group (LRiG), Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Bagust","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group (LRiG), Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Hounsome","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group (LRiG), Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"McLeod","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group (LRiG), Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Boland","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group (LRiG), Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Davis","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group (LRiG), Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Walley","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group (LRiG), Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Dickson","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group (LRiG), Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2009,6]]},"reference":[{"key":"key20210211164949456_ref1-bib1","volume-title":"Guide to the single technology appraisal (STA) process","author":"National Institute for Health and Clinical Excellence","year":"2006"},{"key":"key20210211164949456_ref1-bib2","volume-title":"BCSH guidelines on nodal non-Hodgkin\u2019s lymphoma","author":"British Committee for Standards in Haematology","year":"2002"},{"key":"key20210211164949456_ref1-bib3","author":"North West Haematology Guidelines","year":"2005"},{"key":"key20210211164949456_ref1-bib4","volume-title":"Rituximab for the first-line treatment of stage III\u2013IV follicular non-Hodgkin\u2019s lymphoma","author":"Dundar","year":"2006"},{"key":"key20210211164949456_ref1-bib5","volume-title":"Critical appraisal of secondary research","author":"The University of Sheffield School of Health and Related Research","year":"2006"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2035559","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/publications\/hta13suppl1-04\/hta13suppl1-04.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2035559","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T11:37:24Z","timestamp":1692099444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/hta13suppl1-04"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,6]]},"references-count":5,"aliases":["10.3310\/hta13suppl1\/04"],"journal-issue":{"issue":"Suppl 1","published-online":{"date-parts":[[2009,6]]}},"alternative-id":["10.3310\/hta13suppl1-04"],"URL":"https:\/\/doi.org\/10.3310\/hta13suppl1-04","relation":{},"ISSN":["1366-5278","2046-4924"],"issn-type":[{"value":"1366-5278","type":"print"},{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,6]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"},{"value":"4-2006","name":"date_of_ERG_submission","label":"Date of ERG submission","group":{"name":"article_history","label":"Article History"}},{"value":"7-2007","name":"editorial_review_begun","label":"Editorial review begun","group":{"name":"article_history","label":"Article History"}},{"value":"11-2008","name":"accepted_for_publication","label":"Accepted for publication","group":{"name":"article_history","label":"Article History"}}]}}