OBJECTIVES: Health Canada recently expanded the use of brentuximab vedotin in combination with cyclophosphamide, doxorubicin, prednisone (A+CHP) for the frontline treatment of adult patients with systemic anaplastic large cell lymphoma (sALCL), peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) or angioimmunoblastic T-cell lymphoma (AITL), whose tumours express CD30. The approval was based on results from the ECHELON-2 trial that compared A+CHP to CHOP (CHP plus vincristine) in CD30+ PTCL. Median progression-free survival (PFS) for A+CHP was 48.2 vs 20.8 months for CHOP, providing a significant improvement in PFS and overall survival. This economic evaluation estimated the cost-effectiveness of A+CHP for its newly-approved indication by Health Canada.

METHODS: A partitioned survival model with a 3-week cycle length and lifetime time horizon was developed to simulate the disease course for the modelled population. The 3 health states modelled were PFS, post-progression survival, and death. Efficacy, safety and quality of life data were obtained from ECHELON-2 for the 3 subgroups combined. Medical resource use and costs were derived from Canadian literature and standard sources. Incremental cost-effectiveness ratios (ICERs) per life years (LYs) gained and per quality-adjusted life-years (QALYs) gained were calculated. Deterministic and probabilistic sensitivity analyses were performed to account for uncertainty in key parameters.

RESULTS: A+CHP was associated with an estimated mean gain of 2.90 LYs and 2.38 QALYs and an estimated mean incremental cost of $76,491 vs CHOP; resulting ICERs were $26,340 per LY gained and $32,177 per QALY gained. In sensitivity analyses, time horizon, patient starting age, regimen cost for A+CHP, and discount rate had notable impacts on the results as the ICER was driven by long-term survival gains associated with A+CHP vs CHOP.

CONCLUSIONS: A+CHP provides a cost-effective and clinically-meaningful improvement in treatment options for adults with previously untreated, CD30-expressing sALCL, PTCL-NOS or AITL in Canada, and is within acceptable ICER ranges for oncology medicines.