Cost-Effectiveness Analysis of Brentuximab Vedotin With Chemotherapy in Newly Diagnosed Stage III and IV Hodgkin Lymphoma

Abstract

Purpose In a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) decreased the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). However, the cost effectiveness of incorporating BV (US$6,970 per 50-mg vial) into the first-line setting is unknown. Patients and Methods We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for AVD+BV compared with ABVD as first-line therapy in a cohort of patients with stage III or IV HL. Transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV compared with ABVD from a US payer perspective. Our model was also used to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing. Results AVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. However, incorporating BV into first-line therapy led to significantly higher lifetime health care costs ($361,137 v $184,291), causing the ICER for AVD+BV to be $317,254 per QALY. If indication-specific pricing were implemented, acquisition costs for BV used in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively. Conclusion Substituting BV for bleomycin during first-line therapy for stage III or IV HL is unlikely to be cost effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.

Cost-effectiveness of azacitidine and venetoclax in unfit patients with previously untreated acute myeloid leukemia

“…This economic evaluation comes on the heels of several others that have demonstrated persistently high ICERs for recently approved cancer treatments. [37][38][39][40][41][42] Although some high-cost therapies, such as the use of chimeric antigen receptor T-cell therapy in select B-cell malignancies, 43,44 have been shown to be cost-effective, other high-cost treatments that only marginally improve clinical outcomes and/or require continuous administration are generally of poor economic value. 41 Given the excitement surrounding the use of venetoclax in older, unfit patients with AML, 45,46 it is possible additional venetoclax combinations will be approved for AML treatment in the near future.…”

Real-World Cost-Effectiveness Analysis of Gemcitabine and Cisplatin Compared to Docetaxel and Cisplatin Plus Fluorouracil Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

“…Although drugs vials sharing could control drug wastage, it might cause extensive harm to patients. Moreover, it violates the provisions of Centers for Disease Control and Prevention that single-dose or single-use vials should be used for only one patient ( 30 , 31 ).…”

Cost Effectiveness of Chimeric Antigen Receptor T-Cell Therapy in Multiply Relapsed or Refractory Adult Large B-Cell Lymphoma

“…The challenge with paying for CAR-T raises broader issues with prioritization-whether pharmacologic research and development is optimally incentivized. There are multiple cancer therapies the values of which seem to be inferior to that of CAR-T. [65][66][67][68] Still other therapies were approved by the US Food and Drug Administration without demonstrating overall survival benefit. 69 We should ask whether it is reasonable to continue paying a premium for therapies that provide incremental benefit while budget constraints limit access to more transformative therapies.…”