BRENTUXIMAB VEDOTIN IN RELAPSED/REFRACTORY SYSTEMIC ANAPLASTIC LARGE-CELL LYMPHOMA: A COST-EFFECTIVENESS ANALYSIS
Author(s): ,
Gemma Kay
Affiliations:
ICON Health Economics,ICON plc,Abingdon,United Kingdom
,
Chris Parker
Affiliations:
ICON Health Economics,ICON plc,Abingdon,United Kingdom
,
Eugene Benson
Affiliations:
Takeda UK Ltd,Buckinghamshire,United Kingdom
,
Tanja Podkonjak
Affiliations:
Takeda UK Ltd,Buckinghamshire,United Kingdom
,
Ross Selby
Affiliations:
Global Patient Access,Takeda Oncology,Cambridge,United States
,
Bingxia Wang
Affiliations:
Oncology Statistics,Takeda Pharmaceuticals,Cambridge,United States
Lung-I Cheng
Affiliations:
Global Patient Access,Takeda Oncology,Cambridge,United States
EHA Library. Cheng L. 06/15/18; 215124; PF684
Lung-I Cheng
Lung-I Cheng
Contributions
Abstract

Abstract: PF684

Type: Poster Presentation

Presentation during EHA23: On Friday, June 15, 2018 from 17:30 - 19:00

Location: Poster area

Background
Systemic anaplastic large cell lymphoma (sALCL) is a peripheral T-cell CD30+ non-Hodgkin lymphoma. CHOP chemotherapy is recommended for newly-diagnosed patients; however, 40-65% of patients will experience relapse/have refractory disease (R/R) after frontline treatment. High-dose therapy and autologous stem-cell transplantation (ASCT) can induce long-term remission in 30-40% of these patients. In 2012, the antibody-drug conjugate Brentuximab vedotin (ADCETRIS) was granted a European marketing authorisation for patients with R/R sALCL based on results from the pivotal Phase 2 study (SG035-0004; NCT00866047).

Aims
To evaluate the cost-effectiveness of brentuximab vedotin in patients with R/R sALCL using a UK payer perspective.

Methods
A partitioned survival model comprising three health states (progression-free survival [PFS], post-progression survival, and death) was developed. The relevant comparator was chemotherapy; this was implemented as a composite of five frequently used regimens (ICE, ESHAP, DHAP, GDP, and Gem-P) to reflect clinical practice. Patients achieving an adequate response to salvage therapy were assumed to undergo ASCT or allogeneic stem cell transplant (alloSCT).

Data were obtained from 5-year follow-up from SG035-0004, a systematic literature review and clinical expert opinion. Clinical outcomes (PFS and overall survival [OS]) for brentuximab vedotin, ASCT and alloSCT were extrapolated over lifetime using cure modelling to reflect their curative potential. Clinical outcomes for chemotherapy were based on long-term follow-up for 89 patients in the British Columbia Cancer Agency Lymphoid Cancer database reported by Mak et al. (2013). Brentuximab vedotin and chemotherapy were compared naively given SG035-0004 was a single-arm study. Resource use included drug acquisition and administration; ASCT and alloSCT; adverse events; and long-term follow-up. Costs were based on a UK National Health Service (NHS) and Personal Social Services perspective. Sensitivity analyses included: varying the PFS and OS hazards for chemotherapy, using a self-control comparison to inform chemotherapy PFS and varying the rate of ASCT and alloSCT in both treatment arms. Probabilistic sensitivity analyses were also conducted.

Results
In the absence of ASCT/alloSCT, patients who received brentuximab vedotin experienced an additional 7.8 years mean PFS and additional 13.8 years mean OS compared to chemotherapy. Including ASCT/alloSCT in both arms yielded additional PFS and OS for brentuximab vedotin of 7.1 years and 11.9 years respectively.

The base case incremental cost-effectiveness ratio (ICER) for brentuximab vedotin was £18,728 per quality-adjusted life-year (QALY) based on a drug acquisition cost of £2,500/vial. ICERs for brentuximab vedotin generated by the deterministic sensitivity analysis ranged between £13,000 and £27,000 per QALY. The probabilities of cost-effectiveness were 77% and 97% at decision thresholds of £30,000 and £50,000 per QALY respectively.

Conclusion
The ICER for brentuximab vedotin was below the threshold of £30,000 per QALY in the base case and all deterministic sensitivity analyses. As such, brentuximab vedotin is a cost-effective treatment for patients with R/R sALCL.

Session topic: 36. Quality of life, palliative care, ethics and health economics

Keyword(s): anaplastic large cell lymphoma, Cost effectiveness, Stem cell transplant

Abstract: PF684

Type: Poster Presentation

Presentation during EHA23: On Friday, June 15, 2018 from 17:30 - 19:00

Location: Poster area

Background
Systemic anaplastic large cell lymphoma (sALCL) is a peripheral T-cell CD30+ non-Hodgkin lymphoma. CHOP chemotherapy is recommended for newly-diagnosed patients; however, 40-65% of patients will experience relapse/have refractory disease (R/R) after frontline treatment. High-dose therapy and autologous stem-cell transplantation (ASCT) can induce long-term remission in 30-40% of these patients. In 2012, the antibody-drug conjugate Brentuximab vedotin (ADCETRIS) was granted a European marketing authorisation for patients with R/R sALCL based on results from the pivotal Phase 2 study (SG035-0004; NCT00866047).

Aims
To evaluate the cost-effectiveness of brentuximab vedotin in patients with R/R sALCL using a UK payer perspective.

Methods
A partitioned survival model comprising three health states (progression-free survival [PFS], post-progression survival, and death) was developed. The relevant comparator was chemotherapy; this was implemented as a composite of five frequently used regimens (ICE, ESHAP, DHAP, GDP, and Gem-P) to reflect clinical practice. Patients achieving an adequate response to salvage therapy were assumed to undergo ASCT or allogeneic stem cell transplant (alloSCT).

Data were obtained from 5-year follow-up from SG035-0004, a systematic literature review and clinical expert opinion. Clinical outcomes (PFS and overall survival [OS]) for brentuximab vedotin, ASCT and alloSCT were extrapolated over lifetime using cure modelling to reflect their curative potential. Clinical outcomes for chemotherapy were based on long-term follow-up for 89 patients in the British Columbia Cancer Agency Lymphoid Cancer database reported by Mak et al. (2013). Brentuximab vedotin and chemotherapy were compared naively given SG035-0004 was a single-arm study. Resource use included drug acquisition and administration; ASCT and alloSCT; adverse events; and long-term follow-up. Costs were based on a UK National Health Service (NHS) and Personal Social Services perspective. Sensitivity analyses included: varying the PFS and OS hazards for chemotherapy, using a self-control comparison to inform chemotherapy PFS and varying the rate of ASCT and alloSCT in both treatment arms. Probabilistic sensitivity analyses were also conducted.

Results
In the absence of ASCT/alloSCT, patients who received brentuximab vedotin experienced an additional 7.8 years mean PFS and additional 13.8 years mean OS compared to chemotherapy. Including ASCT/alloSCT in both arms yielded additional PFS and OS for brentuximab vedotin of 7.1 years and 11.9 years respectively.

The base case incremental cost-effectiveness ratio (ICER) for brentuximab vedotin was £18,728 per quality-adjusted life-year (QALY) based on a drug acquisition cost of £2,500/vial. ICERs for brentuximab vedotin generated by the deterministic sensitivity analysis ranged between £13,000 and £27,000 per QALY. The probabilities of cost-effectiveness were 77% and 97% at decision thresholds of £30,000 and £50,000 per QALY respectively.

Conclusion
The ICER for brentuximab vedotin was below the threshold of £30,000 per QALY in the base case and all deterministic sensitivity analyses. As such, brentuximab vedotin is a cost-effective treatment for patients with R/R sALCL.

Session topic: 36. Quality of life, palliative care, ethics and health economics

Keyword(s): anaplastic large cell lymphoma, Cost effectiveness, Stem cell transplant

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