Abstract
We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (hl) in the post-autologous stem-cell transplantation (asct) failure period, from the perspective of the Canadian health care payer. We developed a decision-analytic model to simulate lifetime costs and benefits of brentuximab vedotin compared with best supportive care for the treatment of patients with hl after failure of asct. Administrative data from Ontario were used to set the model parameters. In the base case, treatment with brentuximab vedotin resulted in incremental quality-adjusted life-years (qalys) of 0.544 and an incremental cost of $89,366 per patient, corresponding to an incremental cost-effectiveness ratio (icer) of $164,248 per qaly gained. The icer was sensitive to the cost of brentuximab vedotin, the hazard ratio used to assess the efficacy of brentuximab vedotin treatment, and health state utilities. In light of the available information, brentuximab vedotin has an icer exceeding $100,000 per qaly gained, which is a level often classified as having "weak evidence for adoption and appropriate utilization" in Canada. However, it is worth noting that provincial cancer agencies take into account not only the costs and associated icer, but also other factors such as a lack of alternative treatment options and the clinical benefits of expensive cancer drugs. Pricing arrangements should be negotiated, and risk-sharing agreements or patient access schemes should be explored.
Highlights
Hodgkin lymphoma is an uncommon type of cancer with an incidence of approximately 3 per 100,000 population in Canada[1]
Brentuximab vedotin treatment resulted in an average incremental utility of 0.544 quality-adjusted life-years per person and an average incremental cost of $89,366 per person, which resulted in an icer of $164,248 per qaly gained
The icer fell to $121,092 per qaly gained if patients on brentuximab vedotin treatment had perfect health rather than 0.8 as was assumed in the base case
Summary
Hodgkin lymphoma (hl) is an uncommon type of cancer with an incidence of approximately 3 per 100,000 population in Canada[1]. Conventional treatment options for hl include chemotherapy, radiotherapy, and hematopoietic stem-cell transplantation. The standard of care for young healthy patients who relapse after front-line therapy is salvage chemotherapy, followed by high-dose therapy and autologous stem-cell transplantation (asct). 50% of patients relapse after asct[5], and prognosis tends to be poor for those who relapse, with a short median progression-free survival[6,7]. Third-line treatment options in patients who relapse after asct include allogeneic stem-cell transplantation, a second asct, radiation therapy, and single-agent or combination chemotherapy, all of which are palliative. We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (hl) in the post–autologous stem-cell transplantation (asct) failure period, from the perspective of the Canadian health care payer
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