Cost-Effectiveness Analysis of Common First-Line Treatment for Hodgkin Lymphoma


A recent report published in the Journal of Clinical Oncology (online October 4, 2018; doi:10.1200/JCO.18.00122) analyzed the cost-effectiveness of incorporating brentuximab vedotin (BV) into the first-line setting of stage III/IV Hodgkin lymphoma.

A recent randomized, open-label trial (ECHELON-1) demonstrated a decreased risk of progression in adult patients diagnosed with stage III/IV Hodgkin lymphoma after treatment with BV combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV). This combination therapy yielded more favorable outcomes than the standard regimen containing doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). However, the cost-effectiveness of adding BV into the first-line setting is relatively unknown.

Scott F Huntington, MD, MPH, MSc, Yale School of Medicine, and colleagues designed a Markov decision-analytic model to measure the costs and outcomes of AVD+BV compared with ABVD as first-line therapy in patients with stage III/IV Hodgkin lymphoma. Researchers calculated lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for AVD+BV compared with ABVD from a US payer perspective.

Researchers acknowledged that the model was utilized to estimate BV price reductions that would achieve more favorable cost-effectiveness under indication-specific pricing.

Results of the analysis showed that AVD+BV was associated with an increase of 0.56 QALYs compared with ABVD. However, the addition of BV into the first-line setting was associated with significantly higher lifetime health care costs ($361,137 vs $184,291, respectively). This higher health care cost led the ICER for AVD+BV to be $317,254 per QALY.

Dr Huntington and colleagues noted that after implementing indication-specific pricing, acquisition costs for BV in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively.


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“Substituting BV for bleomycin during first-line therapy for stage III/IV Hodgkin Lymphoma is unlikely to be cost-effective under current drug pricing,” authors of the study concluded. “Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.”

“In the past, studies showing improvement in progression-free survival alone did not dissuade clinicians from using ABVD, with most oncologists waiting for long-term toxicity and survival data of dose-escalated therapy,” they continued. “Only time will tell whether higher costs related to AVD+BV will be a similar deterrent for abandoning ABVD before long-term data are available.”Zachary Bessette