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Randomized Controlled Trial
. 2017 Oct 1;123(19):3763-3771.
doi: 10.1002/cncr.30818. Epub 2017 Jun 22.

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

Lucy Hui  1 , Gottfried von Keudell  2 , Rong Wang  3   4 , Amer M Zeidan  2   3 , Steven D Gore  2   3 , Xiaomei Ma  3   4 , Amy J Davidoff  3 , Scott F Huntington  2   3
Affiliations
Randomized Controlled Trial

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

Lucy Hui et al. Cancer. .

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 remain unclear.

Methods: A Markov decision-analytic model was constructed to measure the costs and clinical outcomes for BV consolidation therapy compared with active surveillance in a cohort of patients aged 33 years who were at risk for HL relapse after 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 QALYs compared with active surveillance plus BV as salvage. However, the strategy of BV consolidation led to significantly higher health care costs ($378,832 vs $219,761), resulting in an ICER for BV consolidation compared with active surveillance of $148,664/QALY. If indication-specific pricing was implemented, then the model-estimated BV price reductions of 18% to 38% for the consolidative setting would translate into ICERs of $100,000 and $50,000 per QALY, respectively. These findings were consistent on 1-way and probabilistic sensitivity analyses.

Conclusions: BV as consolidation therapy under current US pricing is unlikely to be cost effective at a willingness-to-pay threshold of $100,000 per QALY. However, indication-specific price reductions for the consolidative setting could reduce ICERs to widely acceptable values. Cancer 2017. © 2017 American Cancer Society. Cancer 2017;123:3763-3771. © 2017 American Cancer Society.

Keywords: Hodgkin lymphoma; Markov model; autologous stem cell transplantation; brentuximab vedotin; brentuximab vedotin consolidation; consolidation therapy; cost-effectiveness analysis.

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Conflict of interest statement

Conflicts of interest disclosures: A.M.Z. has consulted and received honoraria payments from Celgene, Ariad, Incyte and Pfizer. X.M. consulted for Celgene and Incyte. S.F.H. has received honoraria from Pharmacyclics and consulted for Celgene and Janssen. S.D.G. has consulted for and receives research funding from Celgene and Boehringer Ingelheim. S.D.G. has also consulted for Kyowa, Pfizer, and Seattle Genetics. The remaining authors declare no competing financial interests.

Figures

Figure 1
Figure 1. Markov model of post-ASCT brentuximab vedotin consolidation versus active surveillance with use of brentuximab vedotin rescue at time of HL progression
ASCT indicates autologous stem cell transplantation; BV, brentuximab vedotin.
Figure 2
Figure 2. One-way sensitivity analysis
Brentuximab vedotin consolidation versus active surveillance. BV indicates brentuximab vedotin; Allo, allogenic stem cell transplantation; ASCT, autologous stem cell transplantation; ICER, incremental cost-effectiveness ratios; QALY, quality-adjusted life-years.
See this image and copyright information in PMC

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