Treatment patterns and costs of care for patients with relapsed and refractory Hodgkin lymphoma treated with brentuximab vedotin in the United States: A retrospective cohort study

Abstract

ObjectivesAlthough brentuximab vedotin (BV) has changed the management of patients with relapsed or refractory Hodgkin lymphoma (RRHL), little information is available on routine clinical practice. We identified treatment patterns and costs of care among RRHL patients in the United States (US) treated with BV.MethodsA retrospective observational study of adults initiating BV for RRHL from 2011–2015, with ≥6 months of data prior to and following BV initiation, was conducted. Treatments were classified based on dispensations and chemotherapy administration. Median total and monthly costs were estimated based on all-cause healthcare resource use in 2015 US dollars (USD).ResultsThe cohort comprised 289 patients (59% male; mean age at diagnosis, 42 years) with a mean follow-up of 250 weeks. Eleven percent had BV salvage therapy prior to ASCT, and 32% had BV for a relapse post-ASCT. 43% received treatment post-BV, most commonly allogeneic stem cell transplant (SCT) and bendamustine (both 10.2%). Median (IQR) total costs from BV initiation to censoring were 294,790 (142,110–483,360) USD; and were highest among those treated with BV prior to ASCT (up to 421,900 [300,940–778,970] USD). Median monthly costs were almost 20,000 USD per month, and up to 25,000 USD per month among those with BV and ASCT. Medications were the greatest driver of median monthly costs.ConclusionsMedian total all-cause costs were almost 300,000 USD, and median monthly costs approximately 20,000 USD, per patient treated. Patients requiring treatment following BV continue to incur high costs, highlighting the economic burden associated with managing patients in the RRHL setting.

Real-world analysis of cost, health care resource utilization, and supportive care in Hodgkin lymphoma patients with frontline failure

“… 20 A more recent study among failure patients was done among commercially insured US patients. 13 The average length of FL therapy in the current analysis was 126.5 days, and the average length of follow-up after FLF was 394.8 days, which is shorter than the full follow-up time reported in the most recent study by Szabo et al 13 (498 days), although the minimum follow-up requirement was 6 months compared with only 30 days in the current analysis. The median PPPM cost reported in this study ($13,378) is lower than reported by Szabo et al 13 ($21,980), which is likely due to a shorter follow-up time and a more restrictive population that required everyone to be on BV and have an SCT.…”

“…This retrospective longitudinal cohort study used administrative medical and pharmacy claims data derived from the Mar-ketScan ® Commercial Claims and Encounters (Commercial) and Medicare Supplemental (Medicare) databases, which include complete longitudinal records of inpatient services, outpatient services, long-term care, and prescription drug claims from >40 million employees and dependents annually, covered under a variety of health benefit plans, and is well documented. 13 , 14 All databases were de-identified in compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations.…”

“… 11 The first study by Szabo et al identified prevalent HL patients with an SCT as second-line therapy and reported a median monthly cost of $16,700 during FLT, $38,500 during second line, and $57,800 during third line in HL patients with an SCT that was not followed by BV (naive) therapy. 12 The follow-up Szabo et al 13 study further described the cost of BV therapy in prevalent HL patients and reported that HL patients incurred a monthly median cost of $24,620 during BV treatment. HL is a costly disease, particularly during treatment for relapsed or refractory disease, but little real-world evidence exists describing the costs of supportive care and health care resource utilization (HRU) during FLT as compared with patients with HL who fail FLT for health care providers to understand the potential value of adding novel agents to frontline treatment.…”

Treatment patterns, health care resource utilization, and costs in patients with relapsed/refractory Hodgkin lymphoma treated with brentuximab vedotin

“…Szabo et al [19] recently reported that mean cycles of BV ranged from 2.6 to 8.4, depending on whether patients received BV before or after ASCT or without observed ASCT. Zinzani et al [10,11] evaluated BV use in a systematic review and reported that the median number of BV cycles ranged from 5 to 8 among patients with rrHL treated under the Named Patient Program in which BV was made available to patients from approximately 60 countries for compassionate use before local regulatory approval.…”

“…The current study reported that total costs were $167,152 for BV treatment, with a PPPM cost of $30,434. Total cost from BV initiation to censoring was recently reported to be $294,790, with PPPM costs of approximately $20,000 [19]. Results of another study [23] showed that patients who experienced relapse incurred $311,820 more in unadjusted mean total costs than those who did not ($401,529 ± $262,385 vs $89,709 ± $105,799).…”