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Studies Find Combination Chemotherapy Beneficial and Cost-Effective in Sub-Saharan Africa

July 23, 2021
Lineberger Comprehensive Cancer Center

UNC Lineberger’s Matthew Painschab.

Researchers at the UNC Lineberger Comprehensive Cancer Center demonstrated in a clinical trial in Malawi that a five-drug combination chemotherapy provided curative benefit compared to current standard-of care-therapy in people diagnosed with lymphoma, and now they have determined this option is also cost-effective. The economic finding appeared July 22, 2021, in Lancet Global Health.

The clinical trial results, reported May 19, 2021, in Lancet Global Health involved 37 people with diffuse large B-cell lymphoma (DLBCL). The majority of patients were also HIV-positive, which greatly increased their risk of DLBCL; all HIV-positive patients were treated with anti-viral drugs. The trial participants received a standard four-drug chemotherapy combination known as CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) along with rituximab, an antibody therapy. After two years of follow-up, 55 percent of the patients were still alive, an outcome that is higher than CHOP alone based on earlier studies.

With the trial results in hand, the researchers wanted to know if either CHOP or CHOP plus rituximab were cost-effective treatments in a resource-limited setting. Demographically, Malawi is a sub-Saharan country in Africa with roughly 19 million residents. The healthcare resources available in the 2017-2018 government budget for Malawi were $170 million dollars (about $9 per person); external donors contribute approximately another $350 million annually to health expenditures.

UNC Lineberger’s Matthew Painschab, lead author of the economic analysis and co-lead author of the treatment efficacy study, said cost-effectiveness analyses allow comparisons across diverse diseases so that limited resources can be optimally allocated.

“Without such analyses, relatively expensive upfront costs for cancer medicines will often seem prohibitively costly for a relatively small number of patients compared to other available public health interventions,” said Painschab, assistant professor in the Division of Hematology at UNC School of Medicine and a member of UNC-Project Malawi. “We demonstrated that an upfront, time-limited expense followed by decades of healthy life may be a prudent investment, relative to other accepted interventions such as daily, lifelong antiretroviral treatment for HIV.”

Read more on the UNC Lineberger Comprehensive Cancer Center website.

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