• Scott F Huntington, Gottfried von Keudell, Amy J Davidoff, Cary P Gross, and Sapna A Prasad.
• Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY.
• J. Clin. Oncol. 2018 Oct 4: JCO1800122.

PurposeIn a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) decreased the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). However, the cost effectiveness of incorporating BV (US$6,970 per 50-mg vial) into the first-line setting is unknown.Patients And MethodsWe constructed a Markov decision-analytic model to measure the costs and clinical outcomes for AVD+BV compared with ABVD as first-line therapy in a cohort of patients with stage III or IV HL. Transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV compared with ABVD from a US payer perspective. Our model was also used to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing.ResultsAVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. However, incorporating BV into first-line therapy led to significantly higher lifetime health care costs ($361,137 v $184,291), causing the ICER for AVD+BV to be $317,254 per QALY. If indication-specific pricing were implemented, acquisition costs for BV used in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively.ConclusionSubstituting BV for bleomycin during first-line therapy for stage III or IV HL is unlikely to be cost effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.

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