Cost-effectiveness of brentuximab vedotin in treating increased risk of relapse/progression of classical hodgkin lymphoma patients post autologous stem cell transplant

Abstract

Objective: Hodgkin lymphoma patients who relapsed/progressed early after autologous stem cell transplant (ASCT) usually have poor prognoses. Results from clinical trials have demonstrated Brentuximab vedotin (BV)’s significant clinical effectiveness for consolidation therapy after ASCT for patients who have high risk of relapse/progress. An economic evaluation study for Vietnamese CHL patients is necessary and can provide useful evidence for policymakers. Methods: A multi-stage economic evaluation model consisting of two partitioned survival models was used to estimate incurring costs and effectiveness from health insurance perspective for two hypothetical groups of Vietnamese adult CHL patients who have high risk of relapse/progression, one received standard care and the other received BV consolidation plus standard care as post-ASCT care. Necessary healthcare services were identified via Ministry of Health guidelines and Vietnamese clinical opinions. Efficacy parameters were taken from published systematic review and randomized controlled trials results. Model costs and utility inputs were adapted for Vietnamese context via relevant published literature, guidelines, regulations, and clinical opinions. Model cycle of 1 week and life-time horizon was used. Discounting rate of 3% was applied for cost and effectiveness. Results: Consolidation with BV post-ASCT was estimated to increase treatment cost by 654,502,745 VND per patient, increased 1.295 life years and 2.153 QALYs. Incremental cost-effectiveness ratios were estimated at 505,465,854 VND/LY and 304,045,395 VND/QALY. Conclusions: BV consolidation was not cost-effective compared to 3GDP threshold, however, with an appropriate risk-sharing mechanism, the intervention can be cost-effective, improve patients access to the effective treatment and maintain equity in healthcare.