• Am J Manag Care · Feb 2020

    Cost-effectiveness of brentuximab vedotin with chemotherapy in treatment of CD30-expressing PTCL.

    • Tatyana Feldman, Denise Zou, Mayvis Rebeira, Joseph Lee, Michelle Fanale, Thomas Manley, Shangbang Rao, Joseph Feliciano, Mack Harris, and Anuraag Kansal.
    • Evidera, 7101 Wisconsin Ave, Ste 1400, Bethesda, MD 20814. Email: denise.zou@evidera.com.
    • Am J Manag Care. 2020 Feb 1; 26 (2): e41-e49.

    ObjectivesTo evaluate the cost-effectiveness of brentuximab vedotin (Adcetris) in combination with cyclophosphamide, doxorubicin, and prednisone (A+CHP) in the first-line setting for CD30-expressing peripheral T-cell lymphoma (PTCL).Study DesignAn economic model was developed using clinical and quality-of-life (QOL) data from the ECHELON-2 trial, in which A+CHP demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) versus cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP).MethodsA partitioned survival model, consisting of 3 health states (PFS, postprogression survival, and death), was constructed from a US payer perspective over a lifetime time horizon. PFS and OS observed from ECHELON-2 were extrapolated using standard parametric distributions. The best-fitting distributions (log-normal for both arms) were selected based on statistical goodness of fit and clinical plausibility of the long-term projections. Utilities were based on the European Quality of Life 5-Dimensional data collected in ECHELON-2. Medical resource use and costs were from literature and standard sources.ResultsThe model predicted that A+CHP extended PFS and OS by 2.92 and 3.38 years, respectively, over CHOP. After incorporating QOL and discounting, A+CHP was associated with 1.79 quality-adjusted life-years gained at a total incremental cost of $159,388, resulting in an incremental cost-effectiveness ratio (ICER) of $89,217. Sensitivity analyses provided ICERs ranging approximately from $57,000 to $138,000. The estimated probability that A+CHP is cost-effective compared with CHOP was 82% at a willingness-to-pay threshold of $150,000.ConclusionsBased on the ECHELON-2 trial data, this analysis found A+CHP to be cost-effective for patients with previously untreated CD30-expressing PTCL.

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