Comparison of CHOP and R-CHOP for Treatment non-Hodgkin Lymphoma, Yogyakarta, Indonesia: A Cost-Effectiveness Analysis

Authors

• Woro Supadmi, Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta 55166, IndonesiaFollow
• Rizky Gustinanda, Department of Pharmacy, Faculty of Industry Halal, Nahdlatul Ulama University, Yogyakarta, Indonesia
• Lalu M. Irham, Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta 55166, Indonesia
• Riat El Khair, Department Medical, Dr. Sardjito Central General Hospital, Yogyakarta 55281, Indonesia

Abstract

CHOP and R-CHOP are commonly used chemotherapy regimens for Non-Hodgkin Lymphoma (NHL). While R-CHOP has demonstrated clinical benefits, its higher cost raises concerns regarding economic efficiency, particularly in middle-income countries such as Indonesia. This study aimed to compare direct medical costs and clinical outcomes of CHOP and R-CHOP regimens among NHL patients treated at a national referral hospital in yogykarta. A retrospective cohort study was conducted using medical record data of NHL patients who received CHOP or R-CHOP chemotherapy at Dr. Sardjito General Hospital Yogyakarta, between 2020 and 2023, with follow-up extended until April 30, 2025. Clinical outcomes included overall survival (OS) and observational life years saved (LYS), calculated from treatment initiation until death or study cutoff. OS was analyzed using Kaplan–Meier and Cox proportional hazards models. Direct medical costs were calculated from the hospital perspective. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER) per LYS and interpreted using a willingness-to-pay threshold of 1–3 times Indonesia's GDP per capita. A total of 122 patients were included (61 per group). R-CHOP was associated with higher total direct medical costs than CHOP. Observational LYS and OS during the follow-up period were higher in the R-CHOP group. The ICER per additional LYS for R-CHOP was IDR 59,521,695, which falls below the commonly used WTP threshold. R-CHOP was associated with higher costs and improved observed survival compared to CHOP. However, due to methodological limitations, the findings should be interpreted cautiously and do not establish definitive long-term cost-effectiveness.

Recommended Citation

Supadmi, Woro; Gustinanda, Rizky; Irham, Lalu M.; and Khair, Riat El (2026) "Comparison of CHOP and R-CHOP for Treatment non-Hodgkin Lymphoma, Yogyakarta, Indonesia: A Cost-Effectiveness Analysis," Pharmacology and Clinical Pharmacy Research: Vol. 11: Iss. 1, Article 3.
DOI: 10.15416/pcpr.v11i1.67388
Available at: https://journal.unpad.ac.id/pcpr/vol11/iss1/3

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