Author(s): ,
Abi Vijenthira
Postgraduate Medicine,University of Toronto,Toronto,Canada
Kelvin Chan
Division of Hematology and Medical Oncology,Sunnybrook Health Sciences Centre,Toronto,Canada
Matthew Cheung
Division of Hematology and Medical Oncology,Sunnybrook Health Sciences Centre,Toronto,Canada
Anca Prica
Division of Hematology and Medical Oncology,Princess Margaret Cancer Centre,Toronto,Canada
EHA Library. Vijenthira A. Jun 15, 2019; 266853; PS1236
Abi Vijenthira
Abi Vijenthira

Abstract: PS1236

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Treatment options for advanced-stage Hodgkin lymphoma have expanded to include multiple PET-adapted and non-PET-adapted strategies, which use varying combinations of ABVD and/or BEACOPPescalated. There remains clinical equipoise over the best initial treatment strategy, as traditional strategies of ABVD or BEACOPP alone have similar 10-year overall survival in long-term clinical trial follow-up. Recent PET-adapted trials (RATHL, HD18, AHL2011) have tried to balance the trade-off that occurs with an inferior progression-free survival in the ABVD strategy, but higher rates of hematologic toxicity, infertility, and second malignancy in the BEACOPP strategy. The overall lifetime cost of each strategy remains unknown, especially costs which incorporate therapies for relapsed disease, palliative therapy with nivolumab, treatment for secondary malignancy, and associated health state utilities.

To develop a Markov decision-analytic model to compare the life expectancy, quality-adjusted life expectancy (QALYs), and direct costs with varying upfront treatment regimens for the treatment of a hypothetical cohort of transplant-eligible patients with newly-diagnosed advanced-stage Hodgkin lymphoma.

A Markov decision analytic model was created to simulate patients' clinical course over a 20-year time horizon. Baseline probability estimates and utilities were derived from a systematic review of published studies (i.e. HD2000, Viviani, EORTC, HD15, HD18, RATHL, AHL2011, Echelon-1). A Canadian public health payer's perspective was considered and costs are presented in 2018 Canadian dollars. All costs and benefits were discounted by 1.5%. Sensitivity analyses were performed for key variables.

Based on a 20-year model, life expectancy, QALYs and direct costs respectively were: 12.5 years, 12.1 years, and $94,152 with ABVD, 14.2 years, 12.8 years, and $72,203 with BEACOPP (including HD18), 14.5 years, 13.2 years, and $59,247 with the PET-adapted RATHL protocol, 13.8 years, 12.7 years, and $165,294 with A-AVD, and 14.9 years, 13.4 years, and $58,136 with the PET-adapted AHL2011 protocol. In the base-case analysis, the AHL2011 protocol was associated with both cost-savings and improved quality-adjusted outcomes over all other treatment strategies, making it the dominant treatment strategy (Figure 1A). Sensitivity analyses demonstrated that the model was robust to key variables including probability of treatment-related mortality, probability of death from secondary malignancy, and probability of infertility secondary to BEACOPP. In sensitivity analysis of treatment-related mortality secondary to BEACOPP, the threshold value was found to be 3.2%, a value much greater than that reported in the literature. The threshold utility of infertility was found to be 0.71 (Figure 1B), a value lower than the utility derived from a systemic review of the literature (0.87). Probabilistic sensitivity analyses (10,000 simulations) were performed (Figure 1C). For the WTP threshold of $100,000, AHL2011 was the dominant strategy 73% of the time (Figure 1D).

The preferred treatment strategy for patients with newly diagnosed advanced-stage Hodgkin lymphoma is the AHL2011 PET-adapted regimen. This strategy maximizes life expectancy, quality-adjusted life years, and is the most cost-effective strategy, accounting for increased rates of hematologic toxicity, secondary malignancy, and infertility caused by exposure to at least 2 cycles of BEACOPP. The model was robust to sensitivity analyses of key variables tested through plausible ranges obtained from the published literature.

Session topic: 17. Hodgkin lymphoma - Clinical

Keyword(s): Cost effectiveness, Hodgkin's lymphoma, Second malignancy

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