Painschab MS, Kohler R, Kimani S, et al. - According to current WHO recommendations, curative-intent treatment of diffuse large B-cell lymphoma (DLBCL) in adults in Malawi is cost-effective, particularly for CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and possibly R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). The findings suggest that DLBCL treatment is a wise investment in comparison to other accepted health interventions in low-income and middle-income countries.

• This cost-effectiveness analysis made use of previously published Malawi microcosting data, clinical data from a prospective cohort treated with CHOP, and clinical trial data evaluating R-CHOP.

• On a per-patient basis, compared with best supportive care, CHOP was estimated to save a mean 7·4 disability-adjusted life-years (DALYs) at an incremental cost of US$1384, for an incremental cost-effectiveness ratio (ICER) of $189 per DALY saved, which is significantly lower than the willingness-to-pay threshold (extremely cost-effective).

• When compared with CHOP, R-CHOP was estimated to save 2·8 DALYs at an incremental cost of $3324, yielding an ICER of $1204 per DALY saved, which is slightly higher than the cost-effective willingness-to-pay threshold.

• In probabilistic sensitivity analyses, CHOP was found to be cost-effective for DLBCL treatment in more than 99% of simulations, whereas R-CHOP was found to be less effective in 46% of simulations.