COST-EFFECTIVENESS ANALYSIS OF BRENTUXIMAB VEDOTIN IN ADULTS WITH RELAPSED OR REFRACTORY HODGKIN’S LYMPHOMA

Abstract

Objective: to perform cost-effectiveness analysis of brentuximab vedotin (BV) in patients with relapsed or refractory CD30-positive Hodgkin’s lymphoma (HL). Materials and methods. This study was performed in two parts in 2015. In the first part Markov model was built on the basis of the results of cohort prospective and retrospective studies and clinical expert survey to assess cost-effectiveness of BV in patients with relapsed or refractory CD30-positive HL. Time horizon of the model was 40 years. The model simulated transition between three health states: progression-free, post-progression and death for patients with relapsed or refractory CD30-positive HL after autologous stem cell transplantation (ASCT). Three alternatives were analyzed: 1) chemotherapy with or without radiotherapy (Ch ± RT), 2) Ch ± RT with allogeneic stem cell transplantation (alloSCT) and 3) BV. The economic evaluation was made from the Russian healthcare system point of view. Incremental cost-effectiveness ratio (ICER) for BV vs Ch ± RT and Ch ± RT + alloSCT vs Ch ± RT per life year (LY) and quality-adjusted life year (QALY) was calculated. In the second part we calculated ICER for BV vs standard treatment based on drugs costs only and compared it with ICER for some other costly oncologic drugs, calculated by the same approach. Drugs used for ICER comparison were: bevacizumab for metastatic renal cell carcinoma, eribulin for metastatic breast cancer, panitumumab for adenocarcinoma of the colon or rectum and cabazitaxel for metastatic castration-resistant prostate cancer. ICER was calculated separately for each single drug as the ratio of increment costs of analyzed drug vs the comparator and the increment overall survival; data was derived from clinical trials. Results. In patients with relapsed or refractory CD30-positive HL after ASCT ICER was 5,8 million rub. per LY for BV vs Ch ± RT and 6,4 million rub. for Ch ± RT + alloSCT vs Ch ± RT. Cost of additional month of life for BV in patients with relapsed or refractory CD30-positive HL after ASCT was 524 thousand rub. that was lower than for bevacizumab for metastatic renal cell carcinoma and eribulin for metastatic breast cancer, both drugs included into 2016 Essential and Vital Drugs List: 2,5 million rub. and 923 thousand rub., respectively. Conclusion. In patients with relapsed or refractory CD30- positive HL after ASCT BV is an appropriate alternative as ICER per LY is lower than for standard treatment Ch ± RT + alloSCT vs Ch ± RT. Cost of additional month of life is lower than for other oncologic drugs included into Russian Essential and Vital Drugs List.