OBJECTIVES

: In Canada, the approved frontline therapy for advanced-stage Hodgkin’s Lymphoma (HL) is doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Recently, the clinical efficacy of brentuximab vedotin (A+AVD) compared to ABVD has been demonstrated through a randomized controlled trial in these patients. The objective of this study is to evaluate the cost-effectiveness of A+AVD compared to ABVD.

METHODS

: We constructed a time-dependent Markov model to calculate the incremental costs and effects (in terms of quality-adjusted life-years (QALYs)) of A+AVD versus ABVD. Patients could cycle through a series of health states over a time horizon of 15 years. The length of each cycle was 6 months. Data for the treatment effect of ABVD was obtained from a database of patients at the British Columbia Cancer Agency between 2004 and 2013. A series of scenario analyses were carried out employing differing treatment effect estimates obtained from the published literature for both A+AVD and ABVD. A probabilistic analysis was conducted to estimate concurrent parameter uncertainty on incremental costs and effects. All costs are reported in 2015 Canadian dollars. We took a healthcare system perspective and used a discount rate of 1.5%, as per Canadian guidelines.

RESULTS

: The incremental cost for A+AVD versus standard therapy (ABVD) as frontline therapy in HL patients is $87,000. Treatment with A+AVD resulted in small additional effects, with the incremental QALYs gained estimated at 0.30. The estimated ICER was $280,000/QALY (95% CI: 150,000 to 3,410,000). In the probabilistic analysis, only 24% of simulations resulted in an ICER of less than $100,000 per QALY.

CONCLUSIONS

: Treatment with A+AVD compared to ABVD in patients with HL resulted in a limited QALY gain at substantial cost to the drugs budget. While future analyses based on emerging evidence for A+AVD may decrease decision uncertainty, there is a low probability that ABVD would be considered cost-effective at current prices.