Brentuximab vedotin has shown efficacy in lowering risk of progression of advanced Hodgkin lymphoma as a first-line treatment in adults, but it may not be cost-effective, according to a study published in the Journal of Clinical Oncology.

The recent ECHELON-1 clinical trial had compared therapy consisting of brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (AVD+BV) vs standard chemotherapy consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in adults with newly diagnosed stage III or IV Hodgkin lymphoma. In that trial, AVD+BV showed a 4.9% improvement in modified progression-free survival at 2 years vs ABVD. AVD+BV also lacks the risk of pulmonary toxicity associated with bleomycin.

The new study used a Markov decision-analytic model to analyze cost-effectiveness between the 2 drug regimens that considered differences in cost and in quality-adjusted life-years (QALYs).

AVD+BV delivered an estimated enhancement in QALYs of 0.56 over ABVD in first-line treatment for advanced Hodgkin lymphoma. However, costs were considerably higher for AVD+BV, with a lifetime direct healthcare cost of $361,137 compared with $184,291 for ABVD.

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The incremental cost-effectiveness ratio (ICER) per QALY for AVD+BV vs ABVD in first-line Hodgkin lymphoma treatment was estimated to be $317,254 (95% CI, $159,408-$903,061).

The authors also modeled indication-specific pricing, which showed the acquisition cost of including brentuximab vedotin in first-line treatment of Hodgkin lymphoma would have to be lowered by 56% or 73% to bring the ICER down to $150,000 or $100,000, respectively, per QALY. 

Although the use of brentuximab vedotin has shown clinical benefit in place of bleomycin in first-line chemotherapy for Hodgkin lymphoma, the study authors consider this to be currently not cost-effective and recommended indication-based pricing of this drug. 

Reference

Huntington SF, von Keudell G, Davidoff AJ, Gross CP, Prasad SA. Cost-effectiveness analysis of brentuximab vedotin with chemotherapy in newly diagnosed stage III and IV Hodgkin lymphoma[published online October 4, 2018]. J Clin Oncol. doi: 10.1200/JCO.18.00122