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Abstract
Aims
To support reimbursement requests in Canada, we evaluated the cost-effectiveness of brentuximab vedotin (Adcetris) in combination with cyclophosphamide, doxorubicin, and prednisone (A + CHP) compared with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) as frontline treatment for CD30-expressing peripheral T-cell lymphomas (PTCLs) using results from the ECHELON-2 clinical trial. The PTCL subtypes included were systemic anaplastic large cell lymphoma (sALCL), PTCL–not otherwise specified (PTCL-NOS), and angioimmunoblastic T-cell lymphoma (AITL).
Materials and methods
A partitioned survival model consisting of three health states (progression-free survival [PFS], post-progression survival [PPS], and death) was constructed from the perspective of the Canadian publicly funded healthcare system over a lifetime horizon. Efficacy, safety, and health-related quality-of-life (HRQoL) data were obtained from ECHELON-2. Medical resource use and costs were derived from Canadian literature and standard sources. Incremental cost-effectiveness ratios (ICERs) per life-years (LYs) and quality-adjusted life-years (QALYs) gained were calculated. Sensitivity analyses were performed to account for uncertainty in key parameters. All costs are reported in Canadian dollars.
Results
A + CHP, when compared with CHOP, was associated with an estimated mean gain of 2.90 LYs and 2.38 QALYs and a mean incremental cost of $76,491. The ICER for A + CHP compared with CHOP was estimated at $26,340 per LY gained and $32,177 per QALY gained. In sensitivity analyses, the ICERs remained below $60,000 per QALY gained. Time horizon, patient starting age, and discount rate affected the results, as the ICER was driven by long-term survival gains observed with A + CHP compared with CHOP.
Limitations
Real-world downstream treatments (such as stem cell transplantation) may differ from the treatment protocol followed in the ECHELON-2 trial.
Conclusions
A + CHP compared with CHOP provides a cost-effective treatment option with improved clinical outcomes that are clinically relevant and a comparable safety profile for adults with previously untreated CD30-expressing sALCL, PTCL-NOS, or AITL in Canada.
Transparency
Declaration of funding
This work was sponsored by Seagen Inc.
Declaration of other financial/other relationships
DZ and MH are employees of Evidera, which received funding from Seagen Inc. for the conduct of this study. JL, AK, and WM are former employees of Evidera, which received funding from Seagen Inc. for the conduct of this study. KSY, JL, and KF are employees and shareholders of Seagen Inc.
No potential conflicts of interest were reported by the authors.
Acknowledgements
The authors thank Drs. Isabelle Fleury, Minakshi Taparia, Gizelle Popradi, Eugenia Piliotis, Bence Bruckler, and Mary Margaret Keating for their contributions to the clinical treatment pathways, assumptions, resource use, and data sources in this economic model as they relate to the Canadian healthcare setting. Medical writing support was provided by Ann Cameron, PhD, of Curo (part of the Envision Pharma Group) and Beth Lesher, PharmD, BCPS, of OPEN Health, and was funded by Seagen Inc.
Previous presentations
Zou D, Lee J, Kansal A, et al. Cost-effectiveness Of Brentuximab Vedotin For The Frontline Treatment Of Peripheral T-Cell Lymphomas In Canada [abstract]. Value in Health, Volume 23, S444.