Cost-effectiveness of brentuximab vedotin plus chemotherapy as frontline treatment of stage IV Hodgkin lymphoma in Italy

Objectives: Advanced Hodgkin’s lymphoma (HL) is a rare severe neoplasm, significantly limiting the ability of patients to do daily activities among other impacts of the cancer. Many adult patients present with advanced stage disease (stages III/IV). This analysis investigates the cost-effectiveness of brentuximab vedotin (BV) in combination with doxorubicin, vinblastine, and dacarbarzine (AVD) versus ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) for the frontline treatment of stage IV HL in Italy based on data from the ECHELON-1 clinical trial. Methods: The analysis was conducted from the perspective of the National Health Service using a Markov model with three mutually exclusive health states and a lifetime time horizon. Transition probabilities were taken from the six-year follow-up data of ECHELON-1. Costs were obtained mainly from published literature and national tariffs. For all drugs, ex-factory prices net of the mandatory reductions required by law were considered. Scenarios on possible confidential drug discounts were also explored. Results: BV in combination with AVD was associated with an increase of € 44,551 in total costs of 1.03 life-years (LYs) and 0.85 quality-adjusted life-years (QALYs) as compared with ABVD in the base-case scenario. The incremental cost-effectiveness ratio and the incremental cost-utility ratio were estimated equal to € 43,179/LYs and € 52,257/QALYs, respectively, when based on ex-factory prices. BV in combination with AVD was shown to be a cost-effective option in 24 out of 36 scenarios examining possible confidential discounts (ranging from 0% to 60%) for high-cost drugs included in the analysis based on a € 41,411/QALYs threshold for severe diseases. Conclusions: Based on data from 6 years of follow-up from the ECHELON-1 trial, BV in combination with AVD has the potential to be a cost-effective option versus ABVD for the frontline treatment of stage IV HL in Italy.