A Generic Model for Follicular Lymphoma: Predicting Cost, Life Expectancy, and Quality-Adjusted-Life-Year Using UK Population–Based Observational Data

Han I Wang, Eve Roman, Simon Crouch, Eline Aas, Cathy Burton, Russell Patmore, Alexandra Gwen Smith

Research output: Contribution to journalArticlepeer-review


To use real-world data to develop a flexible generic decision model to predict cost, life expectancy, and quality-adjusted life-years (QALYs) for follicular lymphoma (FL) in the general patient population.

All patients newly diagnosed with FL in the UK’s population-based Haematological Malignancy Research Network (www.hmrn.org) between 2004 and 2011 were followed until 2015 (N = 740). Treatment pathways, QALYs, and costs were incorporated into a discrete event simulation to reflect patient heterogeneity, including age and disease management. Two scenario analyses, based on the latest National Institute for Health and Clinical Excellence (NICE) guidelines (rituximab induction therapy for newly diagnosed asymptomatic patients and rituximab maintenance therapy for patients between treatments), were conducted and their economic impacts were compared to current practice.

Incidence-based analysis revealed expected average lifetime costs ranging from £6,165 [US$7,709] to £63,864 [US$79,862] per patient, and average life expectancy from 75 days to 17.56 years. Prevalence-based analysis estimated average annual treatment costs of £60–65 million [US$75-80 million], accounting for approximately 10% of the United Kingdom’s annual National Health Service budget for hematological cancers as a whole. Assuming that treatment effects reported in trials are applicable to all patient groups, scenario analyses for two recent NICE guidelines demonstrated potential annual cost savings for the United Kingdom that ranged with uptake frequency from £0.6 million to £11 million [US$0.75-2.75 million].

Costs, survival, and QALYs associated with FL vary markedly with patient characteristics and disease management. Allowing the production of more realistic outcomes across the patient population as a whole, our model addresses this heterogeneity and is a useful tool with which to evaluate new technologies/treatments to support healthcare decision makers.

Original languageEnglish
Pages (from-to)1176-1185
Number of pages10
JournalValue in Health
Issue number10
Early online date23 Apr 2018
Publication statusPublished - 1 Oct 2018

Bibliographical note

© 2018, International Society for Pharmacoeconomics and Outcomes Research (ISPOR)


  • cost
  • cost-effectiveness analysis
  • discrete event simulation
  • economic evaluation
  • follicular lymphoma
  • patient level simulation
  • Quality-Adjusted Life Years
  • Humans
  • Lymphoma, Follicular/economics
  • Middle Aged
  • Decision Support Techniques
  • Male
  • Population Surveillance/methods
  • Statistics as Topic/methods
  • Cost-Benefit Analysis/methods
  • Forecasting
  • United Kingdom/epidemiology
  • Aged, 80 and over
  • Adult
  • Female
  • Aged
  • Life Expectancy/trends

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