Economic evaluation of brentuximab vedotin for persistent Hodgkin lymphoma

Background We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (HL) in the post-autologous stem-cell transplantation (ASCT) failure period, from the perspective of the Canadian health care payer. Methods We developed adecision-analytic model to simulate lifetime costs and benefits of brentuximab vedotin compared with best supportive care for the treatment of patients with HL after failure of ASCT. Administrative data from Ontario were used to set the model parameters. Results In the base case, treatment with brentuximab vedotin resulted in incremental quality-adjusted life-years (QALYS) of 0.544 and an incremental cost of $89,366 per patient, corresponding to an incremental cost-effectiveness ratio (ICER) of $164,248 per QALY gained. The ICER was sensitive to the cost of brentuximab vedotin, the hazard ratio used to assess the efficacy of brentuximab vedotin treatment, and health state utilities. Conclusions In light of the available information, brentuximab vedotin has an ICER exceeding $100,000 per QALY gained, which is a level often classified as having "weak evidence for adoption and appropriate utilization" in Canada. However, it is worth noting that provincial cancer agencies take into account not only the costs and associated ICER, but also other factors such as a lack of alternative treatment options and the clinical benefits of expensive cancer drugs. Pricing arrangements should be negotiated, and risk-sharing agreements or patient access schemes should be explored.