NICE has published final guidance (Technology Appraisal 226) on the use of maintenance rituximab for the treatment of follicular non-Hodgkin’s lymphoma (NHL), following response to first-line chemotherapy.

The main efficacy data considered for rituximab in this indication were taken from the PRIMA trial that compared rituximab maintenance with observation in people whose disease had responded to first-line induction therapy.  The Committee concluded from this that rituximab improves progression-free survival (PFS) compared with observation (36 months’ median PFS of 74.9% versus 57.6%, respectively; p<0.0001) but that the size of the overall survival could not be determined.

The Committee noted that the incremental cost-effectiveness ratios (ICERs) varied depending on a number of assumptions and sensitivity analyses, but in most cases were less than £30,000 per QALY gained.  In addition, if the benefits associated with delaying chemotherapy were considered, this would further decrease the ICER to an estimate which would be considered a cost-effective use of NHS resources.

The Committee therefore considered that rituximab maintenance therapy should be recommended as an option for treatment for people with NHL that has responded to first-line induction therapy with rituximab in combination with chemotherapy.

A costing template is available for use by health communities to assess the local financial impact of implementing the recommendations, based on the local population.  This and the full guideline can be accessed via the link below.