Cost-effectiveness of brentuximab vedotin for relapsed or refractory systemic anaplastic large-cell lymphoma in China

Figures & data

Figure 1. Progression free survivor and overall survival, by cohort. (a) Extrapolated progression free survival (Brentuximab vedotin + ASCT curve is overlapped with Chemotherapy + ASCT curve). (b) Extrapolated overall survival (Brentuximab vedotin + ASCT curve is overlapped with Chemotherapy + ASCT curve).

Table 1. Cost inputs.

Category	Details	Cost	Source
Chemotherapy regimen	Proportion [expert’s survey]	Cost per cycle
ICE	25%	$658 [¥4,249]	^21^,^22
DHAP	25%	$141 [¥913]	^21^,^22
GDP	25%	$1,386 [¥8,951]	^21^,^22
Gem-Ox	25%	$1,172 [¥7,570]	^21^,^22
Treatment	Risk of emetics^23^,^24	Cost per week
Brentuximab vedotin	Low	$0.4 [¥2.88]	^21^,^22
ICE	High	$21 [¥133.6]	^21^,^22
DHAP	High	$21 [¥133.6]	^21^,^22
GDP*	High	$21 [¥133.6]	^21^,^22
Gem-Ox*	Low	$0.4 [¥2.88]	^21^,^22
Treatment	Proportion^8	Package cost
Radiotherapy	20%	$4,644 [¥30,000]	^8
ASCT	30% of patients with CR/PR	$30,958 [¥200,000]	^8
Item	Assumption^8	Cost per unit
Single infusion	Costs associated with single infusion for BV	$33 [¥210]	^8
Infusion	Costs associated with infusion for chemotherapy	$156 [¥1010]	^8
CT scan	During treatment 3 times	$108 [¥700]	^8
	Post-treatment once
PET scan	During treatment 2 times	$1,084 [¥7,000]	^8
	Post-treatment once
Blood count	During treatment once per cycle**	$2 [¥15]	^25
Bio chemotherapy	During treatment once per cycle**	$46 [¥300]	^25
Consultation	During treatment once per cycle**	$9 [¥60]	^25

Abbreviations. CR, complete response; PR, partial response.

*The cost of (infection) prevention treatment per cycle for both GDP and Gem-Ox is [$60 ¥388].

**Off-treatment every 3 months for the first two years and every 6 months for the next three years.

Table 2. Utility inputs.

Health state	Without ASCT			With ASCT
				0–6 months		6 months to cure
	Mean	S.D.	Decrement	Utility	Decrement	Utility	Decrement
Base	0.91	N/A	N/A
CR	0.91	0.08	−0.05	0.65	−0.30	0.86	−0.10
PR	0.79	0.17	−0.16	0.54	−0.41	0.74	−0.21
SD	0.71	0.20	−0.24	0.45	−0.50	0.66	−0.29
PD	0.38	0.28	−0.57	0.26	−0.69	0.34	−0.61

Abbreviations. ASCT, autogenic stem cell transplant; CR, complete response; PR, partial response; SD, stable disease; PD, progressed disease.

Figure 2. Predicted progression free survivor and overall survival, by comparator. (a) Predicted progression free survival. (b) Predicted overall survival.

Table 3. Discounted QALYs and LYs, by comparator.

Comparator	QALYs				LYs
	PFS	PPS	AEs	Total	PFS	PPS	Total
Brentuximab vedotin	3.68	0.89	−0.02	4.55	4.60	3.05	7.65
Chemotherapy	1.16	0.51	−0.02	1.65	1.44	1.58	3.02
Incremental	2.52	0.37	0.01	2.90	3.16	1.47	4.63

Abbreviations. QALY, quality-adjusted life year; LY, life year; PFS, progression-free state; PPS, post-progression state; AE, adverse event.

Table 4. Discounted costs by resource category, by comparator.

Comparator	Acquisition	Administration	Concomitant medications	Adverse events	ASCT	Follow-up care	Total
Brentuximab vedotin	$34,171 [¥220,756]	$192 [¥1,241]	$3 [¥17]	$45 [¥289]	$7,789 [¥50,322]	$11,990 [¥77,459]	$54,189 [¥350,084]
Chemotherapy	$6,025 [¥38,922]	$889 [¥5,746]	$260 [¥1,678]	$185 [¥1,195]	$3,939 [¥25,445]	$15,033 [¥97,119]	$26,330 [¥170,105]
Incremental	$28,146 [¥181,833]	−$697 [−¥4,505]	−$257 [−¥1,661]	−$140 [−¥906]	$3,851 [¥24,877]	−$3,043 [−¥19,660]	$27,859 [¥179,979]

Abbreviation. ASCT, autogenic stem cell transplant.

Figure 3. Cost-effectiveness scatter plot.

Figure 4. Cost-effectiveness acceptability curve.

Table

Grade	Adverse event	Cost	Source
1–2	Upper respiratory tract infection	$31 [¥200]	Clinical opinion
	Diarrhea	$0	Clinical opinion
	Nausea	$0	Clinical opinion
	Peripheral sensory neuropathy	$0	Clinical opinion
3–4	Diarrhea	$155 [¥1,000]	Hospitalization for rehydration ¥1,000
	Thrombocytopenia	$57 [¥368.5]	• Hematologist consultation ¥60^25 • Pegfilgrastim: 6 mg syringe ¥365^21
	Peripheral sensory neuropathy	$205 [¥1,322]	• Two neurologist appointments: ¥60 × 2^25 • Gabapentin, regimen: 3000 mg/day for 42 days. 100 × 300 mg capsules ¥602^21 • Ten sessions with a physiotherapist at a cost of ¥60^25
	Thrombocytopenia	$57 [¥368.9]	The same as thrombocytopenia
	Tumor lysis syndrome	$310 [¥2,000]	The same as sepsis
	Nausea	$155 [¥1,000]	The same as diarrhea
	Respiratory failure	$310 [¥2,000]	Clinical opinion
	Sepsis	$1548 [¥10,000]	Clinical opinion
	Pulmonary infection	$310 [¥2,000]	Clinical opinion
	Anemia	$0.6 [¥4]	Blood transfusion • 2 units of blood (the cost is included in the transfusion) • 1 transfusion at ¥4^25
	Leukopenia	$0	Clinical opinion

Table

Deterministic sensitivity analysis	Base case value	DSA value	ICER for brentuximab vedotin (per QALY)	% change relative to the base case
Base case	–	–	$9,610 [¥62,084]
Discount rate (costs, benefits)	5.0% (costs and benefits)	3.0% (costs and benefits)	$7,567 [¥48,885]	−21%
Discount rate (costs, benefits)	5.0% (costs and benefits)	8.0% (costs and benefits)	$12,884 [¥83,236]	34%
Source of response data for brentuximab patients receiving SCT	SG035-0004	Equivalent to chemotherapy	$9,639 [¥62,275]	0%
Brentuximab (no SCT) PFS per INV distribution	Gamma standard model	Exponential cure model	$8,889 [¥57,424]	−8%
Brentuximab (no SCT) OS distribution	Gamma standard model	Kaplan–Meier	$8,970 [¥57,952]	−7%
Brentuximab (no SCT) PFS and OS distribution	Gamma standard model	Lognormal cure model	$8,723 [¥56,375]	−9%
Source of chemotherapy (no SCT) PFS data	Self-control	Mak et al.^6 ALCL (n = 17)	$10,724 [¥69,279]	12%
Source of chemotherapy (no SCT) PFS data	Self-control	Mak et al.^6 PS < 2 (n = 47)	$10,724 [¥69,279]	12%
Chemotherapy (no SCT) PFS distribution	Lognormal	Log-logistic	$9,691 [¥62,607]	1%
Chemotherapy (no SCT) PFS hazard	Original data	Increased 25%	$9,296 [¥60,054]	−3%
Chemotherapy (no SCT) PFS hazard	Original data	Decreased 25%	$10,296 [¥66,515]	7%
Source of chemotherapy (no SCT) OS data	Mak et al.^6 PS < 2 (n = 47)	Mak et al.^6 ALCL (n = 17)	$9,211 [¥59,504]	−4%
Chemotherapy (no SCT) OS distribution	Lognormal	Kaplan–Meier	$9,807 [¥63,359]	2%
Chemotherapy (no SCT) OS hazard	Original data	Increased 25%	$9,079 [¥58,656]	−6%
Chemotherapy (no SCT) OS hazard	Original data	Decreased 25%	$10,648 [¥68,793]	11%
ASCT PFS distribution	Gamma cure model	Lognormal cure model	$9,494 [¥61,335]	−1%
ASCT OS distribution	Lognormal cure model	Gamma cure model	$9,642 [¥62,293]	0%
ALCL calibration for ASCT	Exclude	Include	$8,728 [¥56,384]	−9%
Rate of stem cell transplant	30% (Clinical opinion)	SGN35 0004	$9,599 [¥62,017]	0%
Rate of stem cell transplant	30% (Clinical opinion)	BV reduced to 15%	$9,651 [¥62,348]	0%
Cured time-point (years)	5 years	2 years	$9,506 [¥61,413]	−1%
Adverse event disutilities	Include	Exclude	$9,634 [¥62,237]	0%
Chemotherapy costs; all patients receive cheapest	Mix	DHAP	$11,076 [¥71,553]	15%
Chemotherapy costs; all patients receive most expensive	Mix	GDP	$8,365 [¥54,040]	−13%
Utility score of response category	UK-based score	South Korean-based score	$11,023 [¥71,210]	15%

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