OBJECTIVES

Systemic anaplastic large cell lymphoma (sALCL) is a rare type of non-Hodgkin lymphoma and one of the subtypes of peripheral T-cell lymphoma. The objective of this study was to estimate the cost-effectiveness of brentuximab vedotin (BV) in combination with cyclophosphamide, doxorubicin and prednisone (CHP) chemotherapy versus current chemotherapies in France.

METHODS

A cost-effectiveness analysis was developed using a three-state partitioned survival model (progression-free survival, post-progression survival, death) over a lifetime (35-year) horizon to compare BV+CHP to chemotherapies from a collective perspective. The simulated population and the clinical effectiveness for BV+CHP were based on the pivotal clinical trial ECHELON-2 results. The main comparator included in this analysis was cyclophosphamide, doxorubicin, etoposide, vincristine and prednisone (CHOEP) chemotherapy with relative efficacy/effectiveness and safety data derived from a network meta-analysis. Costs were measured in 2020 euros and effects measured in quality-adjusted life years (QALYs). These were evaluated with a discount rate of 2.5% and 1.5% per annum before and after 30-years, respectively, according to French guidelines. Uncertainty associated to methodological assumptions and model parameters was addressed through scenario analyses and deterministic/probabilistic sensitivity analyses.

RESULTS

Over a lifetime horizon, the regimen of BV+CHP versus CHOEP was associated with 3.6 QALYs gained at a total incremental cost of 43 844€, resulting in an incremental cost-effectiveness ratio (ICER) of approximately 12 211€. According to overall survival extrapolation, BV+CHP was associated with an extension of 4.4 life years. The probabilistic sensitivity analyses generated a 95%CI of [0€ ; 40 900€] and an 80% probability of being cost-effective based on a willingness to pay (WTP) of 19 000€/QALY.

CONCLUSIONS

The regimen of BV+CHP is estimated to improve life expectancy by 4.4 years over a lifetime horizon and is likely to be cost-effective in France, with an ICER of 12 211€, based on conventional WTP threshold in patients suffering from sALCL.