Cost-effectiveness analysis of brentuximab vedotin with chemotherapy in newly diagnosed stage III/IV Hodgkin lymphoma.

6609 Background: In a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin combined with doxorubicin, vinblastine, and dacarbazine (A+AVD) decreased the risk of progression in adults diagnosed with stage III/IV Hodgkin lymphoma (HL) compared to standard bleomycin-containing chemotherapy (ABVD). However, the cost-effectiveness of incorporating brentuximab vedotin into the first-line setting is unknown. Methods: We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for A+AVD compared to ABVD as first-line therapy in a cohort of patients with stage III/IV HL. Progression-free survival and transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Centers for Medicare & Medicaid Drug Pricing Files from December 2017 were used for drug costs (106% of average sales price). Additional expenditures and clinical utilities were estimated from literature. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for A+AVD compared with ABVD from a societal perspective within the United States. Our model was also used to estimate price reductions of brentuximab vedotin that would achieve more favorable cost-effectiveness under indication-specific pricing. Results: A+AVD was associated with an improvement of 0.48 QALYs compared to treatment with standard ABVD. However, incorporating brentuximab vedotin into first-line therapy led to significantly higher lifetime costs ($334,863 versus $193,780), causing the ICER for A+AVD compared with ABVD to be $292,266/QALY. If indication-specific pricing was implemented, price reductions of brentuximab vedotin by 40% to 60% in the first-line setting would produce ICERs of $100,000 to $150,000/QALY. Conclusions: Substituting brentuximab vedotin for bleomycin during first-line therapy for stage III/IV HL is unlikely to be cost-effective under current drug pricing. Should indication-specific pricing be implemented, discounting brentuximab vedotin in the first-line setting by 40% to 60% could reduce ICERs to widely acceptable values.