OBJECTIVES: Advanced Hodgkin's lymphoma (HL) is a rare severe neoplasm that particularly affects young adults of working age and older people significantly limiting their ability to carry out daily activities. Advanced stage disease at diagnosis is seen in about 40% of patients, and outcomes are historically less favourable in these patients. Classically, first-line treatment with doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD) has been the standard of care in advanced stage classic Hodgkin’s lymphoma. Nevertheless, a considerable proportion of patients with stage III/IV disease relapse and/or become refractory to ABVD therapy. This analysis investigates the cost-effectiveness of brentuximab vedotin in combination with AVD (A+AVD) versus ABVD for the treatment of stage III Hodgkin’s lymphoma in Italy, the most recent indication approved by EMA on 12 October 2023.

METHODS: The analysis was conducted from the National Health Service (NHS) perspective using as a Markov model structure with three mutually exclusive health states, weekly cycles, and a lifetime time horizon. Transition probabilities were derived from the ECHELON-1 six-year survival data. Cost inputs were obtained mainly from published literature and national tariffs. Costs, life years (LYs) and quality-adjusted life years (QALYs) were discounted by 3%. Deterministic and probabilistic sensitivity analyses were conducted to handle uncertainty of the model parameters.

RESULTS: A+AVD was associated with a total cost increase of € 25,523, as well as an incremental 0.75 LYs and 0.62 QALYs gained compared with ABVD. Thus, the incremental cost-effectiveness ratio and the incremental cost-utility ratio were estimated l to be € 34,162/LY and € 41,095/QALY respectively.

CONCLUSIONS: Considering the national willingness-to-pay threshold observed in Italy for a more severe disease is € 41,411 per QALY gained, A+AVD can be considered a cost-effective treatment option compared to ABVD for the treatment of patients with stage III HL.