OBJECTIVESThe objective of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with standard of care (SoC) therapy for the treatment of erythrodermic (stage T4, MO) cutaneous T-cell lymphoma (CTCL) patients, who are refractory to one or more systemic treatments. The perspective of the analysis was that of the Australian health care system.METHODSPatients with CTCL often cycle through multiple lines of therapies. To determine the placement of ECP and the comparator therapies a treatment survey was conducted. A Markov model was developed with health states based on treatment sequencing with ECP and other SoC therapies available in the Australian setting (e.g. methotrexate, interferon, vorinostat and brentuximab vedotin). Transitions between health states were modelled from time-to-next-treatment data from a published Australian observational study of ECP and comparator treatments. Utility values were based on treatment response rates. Given the lack of utility data in patients with CTCL, utility values for psoriasis were used as a reasonable proxy for CTCL, which was validated by consultation with local clinicians. The time horizon for the model was 5 years.RESULTSIncluding ECP as a second-line treatment option for CTCL dominated over other treatment strategies in terms of cost-effectiveness. This occurred as ECP displaced expensive pharmaceutical therapies (i.e. a greater proportion of patients avoided subsequent treatment with the high-cost treatment options vorinostat and brentuximab vedotin). In addition, ECP was associated with an incremental quality-adjusted life year (QALY) gain of between 0.20 and 0.21. This was attributable to patients being able to better tolerate ECP and therefore, remaining on therapy for a longer period with a higher quality of life compared with comparator treatments.CONCLUSIONSThis analysis demonstrates that ECP is a cost-effective option for the treatment of erythrodermic CTCL patients in an Australian population compared with other SoC therapies.
Conference/Value in Health Info
2020-05, ISPOR 2020, Orlando, FL, USA
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