169 Estimated Cost-Effectiveness of Brentuximab Vedotin Vs. Best Supportive Care Following Autologous Stem Cell Transplant in Hodgkin's Lymphoma

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Scott D. Ramsey, MD, PhD , Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Joshua Roth, PhD , Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Joshua Carlson, PhD , Pharmacy, University of Washington, Seattle, WA
Presentation recording not available for download or distribution as requested by the presenting author.

Topic Significance & Study Purpose/Background/Rationale

Hodgkin Lymphoma (HL) that relapses following autologous stem cell transplant (ASCT) is costly to treat and carries an unfavorable prognosis. Brentuximab vedotin  (BV), a novel agent to reduce the risk of relapse following ASCT, offers the potential to be both effective and cost-effective.  Anticipating the results of the AETHERA trial, we constructed a decision model to estimate the cost-effectiveness of BV vs. best supportive care (BSC) for adult HL patients at high risk of relapse following ASCT.

Methods, Intervention, & Analysis

The model is constructed as a Markov process, taking the U.S. health insurer perspective and a lifetime horizon. Following ASCT, high-risk HL patients are treated with BV or BSC alone. After treatment, patients enter one of 5 health states: remission; relapse/salvage therapy; relapse/palliative care; 2nd remission; death. Transition probabilities were based on published reports, bone marrow transplant registry data, and life tables. Drug cost was ASP + 6%. Costs are based on 2013 Medicare reimbursements.

Findings & Interpretation

In the base case (HR 0.667 for BV vs. BSC), total life years, QALYs, and costs were 16.7, 13.4, and $308,000 for the BV strategy vs. 14.3, 10.9, and $140,000 for the BSC strategy. The cost per life year gained and cost per QALY gained for BV vs. BSC were $70,000 and $67,200, respectively. Economic outcomes across a range of hazard ratios (HR) for BV vs BSC are as follows:

BV Relapse HR vs. BSC

0.5

0.6

0.7

0.8

Life Years Gained

3.8

2.9

2.1

1.3

QALYs Gained

4.1

3.1

2.3

1.4

Additional Cost

$155,000

$162,000

$169,000

$176,000

Cost Per Life Year Gained

$40,789

$55,862

$80,476

$135,384

Cost Per QALY Gained

$37,804

$52,258

$73,478

$125,714

Results were most sensitive to: (a) efficacy of BV (relapse HR), (b) monthly drug cost, and (3) cycles of treatment. In the base case, the likelihood of BV being cost-effective was 92.6% at a willingness to pay threshold of $100,000 per QALY.

Discussion & Implications

BV has the potential to be cost-effective in HL patients at risk for relapse following ASCT.  The AETHERA trial will provide more precise estimates of the cost-effectiveness of this therapy.

Disclosures:
S. D. Ramsey, Seattle Genetics, none: Consultancy

J. Roth, Seattle Genetics, none: Consultancy

J. Carlson, Seattle Genetics, none: Consultancy
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