The Cost-Effectiveness of Brentuximab Vedotin As Consolidation Treatment After Autologous Stem-Cell Transplantation in Patients With Hodgkin Lymphoma and Increased Risk of Relapse

Abstract

To assess the cost-effectiveness of brentuximab vedotin (BV) as consolidation treatment for patients diagnosed with Hodgkin Lymphoma (HL) who have an increased risk of relapse following autologous stem cell transplant (ASCT), in a Swedish healthcare setting. A Markov model with area under the curve (AUC) components, with a lifetime horizon, was constructed to compare BV to best supportive care (BSC) as consolidation treatment following an ASCT. Costs and outcomes of subsequent treatments for patients experiencing relapse were also incorporated in to the model. Clinical effectiveness for BV and BSC as consolidation treatment was based on the double blind randomized controlled phase III study AETHERA. Data on the effectiveness of subsequent treatments were collected from published data from the literature and from pivotal clinical trial results for BV in relapsed and refractory HL. Costs and epidemiological parameters were relevant to Sweden. Outcomes were measured in quality adjusted life years (QALYs). Both costs and effects were discounted at 3 % as according to Swedish guidelines. To assess uncertainty, univariate deterministic and multivariate probabilistic sensitivity analyses (PSA) were performed. The estimated incremental cost-effectiveness ratio (ICER) of BV compared to BSC was SEK 409 000 (€ 42 000). One-way sensitivity analyses showed that the results were stable when central variables were varied. The PSA also showed that the model was robust and indicated that BV, as consolidation treatment following ASCT, had a high probability of being cost-effective at the willingness-to pay thresholds accepted in Sweden. The estimated ICER was robust and below the accepted willingness-to-pay for a QALY in Sweden considering the severity of the disease. Our model indicates that consolidation treatment with BV following an ASCT is cost-effective for patients diagnosed with Hodgkin Lymphoma who have an increased risk of relapse following an ASCT, when compared to BSC in the Swedish healthcare setting.