Cost‐effectiveness analysis of consolidation with brentuximab vedotin for high‐risk Hodgkin lymphoma after autologous stem cell transplantation

Abstract

Background In a recent randomized placebo-controlled trial, consolidation treatment with brentuximab vedotin (BV) decreased the risk of Hodgkin lymphoma (HL) progression after autologous stem-cell transplantation (ASCT). However, the impact of BV consolidation on overall survival, quality of life, and health care costs are unclear. Methods We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for BV consolidation therapy compared to active surveillance in a 33-year-old patient cohort at risk for HL relapse following ASCT. Life-time costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each post-ASCT strategy. Results After quality-of-life adjustments and standard discounting, upfront BV consolidation was associated with an improvement of 1.07 quality-adjusted-life years (QALYs) compared to active surveillance with BV as salvage. However, the strategy of BV consolidation led to significantly higher healthcare costs ($378,832 versus $219,761), causing the ICER for BV consolidation compared with active surveillance to be $148,664/QALY. If indication-specific pricing were implemented, our model estimates BV price reductions of 18% to 38% for the consolidative setting would translate to ICERs of $100,000/QALY and $50,000/QALY, respectively. Findings were consistent on one-way and probabilistic sensitivity analyses. Conclusions BV as consolidation at current US pricing is unlikely to be cost-effective at a willingness to pay threshold of $100,000/QALY. However, indication-specific price reductions for the consolidative setting could reduce ICERs to widely acceptable values.

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

“…30,31,42 Overall, health states after ASCT were similar to our prior model used to assess the cost effectiveness of BV in the post-transplantation setting. 25…”

“…Because quality-of-life data comparing AVD+BV to ABVD are not currently available, we were conservative and range by expert opinion Probability of death during ABVD treatment 0.0197 0.006-0.02 Viviani et al, 5 Johnson et al, 6 Connors et al 8 9 Chen et al, 26,27 Moskowitz et al, 28 Probability of remission after BV salvage 0.09 0.05-0.13 Younes et al, 9 Chen et al, 26 Gopal et al 32 Probability of durable remission after allo-SCT 0.54 0.32-0.59 Chen et al, 27 Moskowitz et al, 28 Anderlini et al 29 Average survival with refractory disease, years 2.5 1.0-3. 5 Hui et al, 25 Arai et al, 33 Kaloyannidis et al, 34 Abbreviations: ABVD, doxorubicin, bleomycin, vinblastine, and dacarbazine; AVD+BV, brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine; allo-SCT, allogeneic stem-cell transplantation; ASCT; autologous stem-cell transplantation; BV, brentuximab vedotin; PFS, progression-free survival. Abbreviations: ABVD, doxorubicin, bleomycin, vinblastine, and dacarbazine; allo-SCT, allogeneic stem-cell transplantation; ASCT, autologous stem-cell transplantation; AVD, doxorubicin, vinblastine, and dacarbazine; CPT, Current Procedural Terminology.…”

Impact of imaging modality on clinical outcome in Hodgkin lymphoma in a resource constraint setting

“…The treatment of Hodgkin lymphoma (HL) has evolved over the last few decades based on PET‐CT assessment and risk‐stratified therapy (Cheson et al , ). Current costing studies in HL have focused more on the use of brentuximab in HL therapy (Engstrom, ; Babashov et al , ) and on the use of brentuximab in relapsed HL requiring salvage therapy and an autologous transplant (Hui et al , ; Parker et al , ). The available data on costing in upfront HL is scant, and comes from the pre‐PET era (Norum et al , ).…”

Targeted Drug Brentuximab Vedotin for Treatment of Relapsed or Refractory Cd30-Positive Hodgkin’s Lymphoma

“…Три исследования оценива-ют применение БВ у пациентов с р / р ЛХ после аутоТГСК [31][32][33], одно -у пациентов с риском рецидива ЛХ после аутоТГСК [34].…”

“…Ва-рианты схем разделения рисков, используемых в Евро-пейском союзе, представлены в публикации Борковски и др. [35] В публикации Hui et al была построена Марковская модель для сравнения консолидационной терапии БВ и активного наблюдения в когорте пациентов в возрасте 33 лет с риском рецидива ЛХ после аутоТГСК [34].…”