Huntington SF, et al. - Given that the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) has been reported to be lowered by brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) vs standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]) in a recent randomized, open-label trial (ECHELON-1), researchers assessed the cost effectiveness of including BV (US $6,970 per 50-mg vial) in the first-line setting. Under current drug pricing, it is doubtful that substituting BV for bleomycin during first-line therapy for stage III or IV HL will be cost effective. Reduction in acquisition costs for BV used in the first-line setting by 56% to 73% would be required for incremental cost-effectiveness ratios of $150,000 to $100,000 per quality-adjusted life-year, respectively, if indication-specific pricing were implemented.

Methods

• In a cohort of patients with stage III or IV HL, the costs and clinical outcomes for AVD+BV vs ABVD as first-line therapy were determined using a Markov decision-analytic model constructed by researchers.
• From ECHELON-1, estimation of transition probabilities was done by fitting parametric survival distributions.
• From a US payer perspective, they calculated lifetime direct health care costs, QALYs, and ICERs for AVD+BV vs ABVD.
• They also used this model to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing.

Results

• Findings demonstrated an improvement of 0.56 QALYs in relation to AVD+BV vs treatment with standard ABVD.
• However, significantly higher lifetime health care costs ($361,137 v $184,291) resulted from incorporating BV into first-line therapy, causing the ICER for AVD+BV to be $317,254 per QALY.