Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation

Lucy Hui, Gottfried von Keudell, Rong Wang, Amer M. Zeidan, Steven D. Gore, Xiaomei Ma, Amy J. Davidoff, Scott F. Huntington

Research output: Contribution to journalArticle

Abstract

BACKGROUND: In a recent randomized, placebo-controlled trial, consolidation treatment with brentuximab vedotin (BV) decreased the risk of Hodgkin lymphoma (HL) progression after autologous stem cell transplantation (ASCT). However, the impact of BV consolidation on overall survival, quality of life, and health care costs remain unclear. METHODS: A Markov decision-analytic model was constructed to measure the costs and clinical outcomes for BV consolidation therapy compared with active surveillance in a cohort of patients aged 33 years who were at risk for HL relapse after ASCT. Life-time costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each post-ASCT strategy. RESULTS: After quality-of-life adjustments and standard discounting, upfront BV consolidation was associated with an improvement of 1.07 QALYs compared with active surveillance plus BV as salvage. However, the strategy of BV consolidation led to significantly higher health care costs ($378,832 vs $219,761), resulting in an ICER for BV consolidation compared with active surveillance of $148,664/QALY. If indication-specific pricing was implemented, then the model-estimated BV price reductions of 18% to 38% for the consolidative setting would translate into ICERs of $100,000 and $50,000 per QALY, respectively. These findings were consistent on 1-way and probabilistic sensitivity analyses. CONCLUSIONS: BV as consolidation therapy under current US pricing is unlikely to be cost effective at a willingness-to-pay threshold of $100,000 per QALY. However, indication-specific price reductions for the consolidative setting could reduce ICERs to widely acceptable values.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - 2017

Keywords

  • Autologous stem cell transplantation
  • Brentuximab vedotin
  • Brentuximab vedotin consolidation
  • Consolidation therapy
  • Cost-effectiveness analysis
  • Hodgkin lymphoma
  • Markov model

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Hui, L., von Keudell, G., Wang, R., Zeidan, A. M., Gore, S. D., Ma, X., Davidoff, A. J., & Huntington, S. F. (Accepted/In press). Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation. Cancer. https://doi.org/10.1002/cncr.30818