OBJECTIVES: Treatment of classical Hodgkin Lymphoma (cHL) is highly effective in early lines of treatment; however, for patients who relapse or become refractory after receiving both autologous haematopoietic cell transplantation (auto-HCT) and brentuximab vedotin (BV), treatment options are extremely limited. Nivolumab is a PD-1 inhibitor that may potentially offer significant improvements in disease control and quality-of-life over standards of care (SoC) in this setting. Additionally, nivolumab may enable allogeneic HCT (allo-HCT), a potentially curative procedure. The objective of this study was to estimate the clinical- and cost-effectiveness of nivolumab compared to SoC.

METHODS: A three-state Markov disease progression and cost-effectiveness model of CHL was developed. Relative efficacy was established by naïve and adjusted comparisons of patient-level clinical trial data (nivolumab; CA209-039 and CheckMate 205 B and C) with a retrospective study (SoC; Cheah 2016). Costs were derived from published UK estimates; remaining model inputs were consistent with previous UK health technology assessments. A lifetime horizon was applied; costs and benefits were discounted at 3.5% annually (£GBP 2014-15). An additional scenario was modelled in which a proportion of patients received allo-HCT after 6 months of treatment, dependent on response.

RESULTS: Nivolumab resulted in an estimated additional 2.80 quality-adjusted life years (QALYs) and 2.90 life years versus SoC, with 1.67 years spent in the pre-progression state and 3.34 years in the post-progression state (versus 0.41 and 1.70 years for SoC, respectively). Estimated incremental costs were £82,897 with a resultant incremental cost-effectiveness ratio (ICER) of £29,631/QALY. Assuming a proportion of patients receive allo-HCT resulted in an ICER of £16,457/QALY.

CONCLUSIONS: Nivolumab is estimated to offer significant benefit in terms of improved survival and quality-of-life whilst offering a cost-effective alternative to SoC, addressing a significant unmet need in people with relapsed or refractory cHL who have received both auto-HCT and BV.