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Cost-effectiveness analysis of PET-guided BrECADD with chemotherapy in advanced-stage, classical Hodgkin lymphoma
Guihao Zeng1,2,3, Bikun Cai1,2,3, Hui Zhang4,5,6
1School of Medical Business, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China.
Objective:
The HD21 trial demonstrated efficacy and safety of brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine, and dexamethasone (BrECADD) vs. bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) as frontline therapy for advanced-stage, classical Hodgkin lymphoma. This analysis evaluated the cost-effectiveness of BrECADD from a US healthcare payer perspective.
Methods:
Building upon a multicenter, randomized, open-label phase 3 HD21 trial (NCT02661503) that evaluated BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma patients, we constructed a Markov model with 3-week cycles over a 50-year horizon. The model's primary outcomes encompassed total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios, with all economic parameters discounted at 3.0% annually. Cost-utility analyses employed a willingness-to-pay threshold of $100,000 per QALY, supplemented by comprehensive sensitivity and scenario analyses to verify model robustness.
Results:
Economic evaluation demonstrated that compared to eBEACOPP, the BrECADD regimen yielded an additional 2.24 QALYs at an incremental cost of $113,134.17, producing an ICER of $50,411.69/QALY, substantially below the $100,000 WTP threshold. One-way sensitivity analysis identified BrECADD drug acquisition costs and health state utility values as the predominant model drivers; all ICERs remained below the $100,000 WTP threshold across the plausible ranges of all parameters. Probabilistic sensitivity analysis indicated that at a willingness-to-pay threshold of $100,000 per QALY, BrECADD was cost-effective compared to eBEACOPP in 100% of 1000 Monte Carlo iterations. The cost-effectiveness acceptability curve demonstrated that BrECADD achieved a greater than 50% probability of being cost-effective at WTP thresholds above approximately $55,000 per QALY.
Conclusions:
BrECADD can be considered a cost-effective treatment versus eBEACOPP in treating advanced-stage, classical Hodgkin lymphoma in America.
Clinical Trial Number:
Not applicable.