Cost-effectiveness of brentuximab vedotin in advanced stage Hodgkin’s lymphoma: a probabilistic analysis

BMC Cancer

S. Costa¹  D. Cameron²  A. J. N. Raymakers³  D. A. Regier⁴ 

[1] Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 2nd floor, 675 West 10th Avenue, V5Z 1L3, Vancouver, BC, Canada;Health Economics Analytic Support and Research Unit (HEASRU), BC Cancer, Vancouver, Canada;Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 2nd floor, 675 West 10th Avenue, V5Z 1L3, Vancouver, BC, Canada;Health Economics Analytic Support and Research Unit (HEASRU), BC Cancer, Vancouver, Canada;Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 2nd floor, 675 West 10th Avenue, V5Z 1L3, Vancouver, BC, Canada;Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada;Health Economics Analytic Support and Research Unit (HEASRU), BC Cancer, Vancouver, Canada;Canadian Centre for Applied Research in Cancer Control (ARCC), BC Cancer Research Centre, 2nd floor, 675 West 10th Avenue, V5Z 1L3, Vancouver, BC, Canada;School of Population and Public Health, University of British Columbia, Vancouver, Canada;

关键词: Hodgkin’s lymphoma;    Economic evaluation;    Brentuximab vedotin;    Cost-effectiveness;   

DOI  :  10.1186/s12885-020-07374-3

来源: Springer

【 摘 要 】

BackgroundTreatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) is a well-established therapy for advanced Hodgkin’s lymphoma (HL). However, the recently completed ECHELON-1 trial showed potential net clinical benefit for brentuximab vedotin (BREN+AVD) compared to ABVD as frontline therapy in patients with advanced Hodgkin’s lymphoma. The objective of this analysis is to determine whether, on current evidence, BREN+AVD is cost-effective relative to ABVD as frontline therapy in patients with advanced HL.MethodsWe constructed a probabilistic Markov model with two arms and six mutually exclusive health states, using six-month cycle lengths, and a 15-year time horizon. Time-dependent transition probabilities were calculated from ‘real-world’ data collected by the BC Cancer’s Centre for Lymphoid Cancer database or from the literature for ABVD. Time-dependent transition probabilities for BREN+AVD were taken from the ECHELON-1 trial. We estimated the incremental cost and effects per patient of each therapy and calculated the incremental cost-effectiveness ratio (ICER). Costs were measured in 2018 Canadian dollars and effects measured in quality-adjusted life years (QALYs). A probabilistic analysis was used to generate a cost-effectiveness acceptability curve (CEAC).ResultsThe incremental cost between standard therapy with ABVD and therapy with BREN+AVD was estimated to be $192,336. The regimen of BREN+AVD resulted in a small benefit in terms of QALYs (0.46 QALYs). The estimated ICER was $418,122 per QALY gained. The probabilistic analysis suggests very few (8%) simulations fall below $100,000 per QALY. Even at a threshold of $200,000 per QALY gained, there was only a 24% chance that BREN+AVD would be considered cost-effective. Sensitivity analyses evaluating price reductions for brentuximab showed that these reductions needed to be in excess of 70% for this regimen to be cost-effective at a threshold of $100,000 per QALY.ConclusionsThere may be a clinical benefit associated with BREN+AVD, but on current evidence the benefit is not adequately substantive compared to ABVD therapy given the cost of brentuximab vedotin. Agencies responsible for making decisions about BREN+AVD as frontline therapy for patients with advanced HL should consider whether they are willing to implement this treatment given the current uncertainty and cost-benefit profile, or negotiate substantial price-reductions from the manufacturer should they choose to reimburse.

【 授权许可】

CC BY