Cost-effectiveness of brentuximab vedotin in Hodgkin lymphoma: a systematic review

Eur J Clin Pharmacol. 2023 Nov;79(11):1443-1452. doi: 10.1007/s00228-023-03557-6. Epub 2023 Sep 1.

Abstract

Purpose: This study aimed to systematically review and critically appraise cost-effectiveness studies on Brentuximab vedotin (BV) in patients with Hodgkin lymphoma (HL).

Methods: The PubMed, Scopus, Web of Science core collection, and Embase databases were searched until July 3, 2022. We included published full economic evaluation studies on BV for treating patients with HL. The methodological quality of the studies was assessed using the Quality of Health Economic Studies (QHES) checklist. Meanwhile, we used qualitative synthesis to analyze the findings. We converted the incremental cost-effectiveness ratios (ICERs) to the value of the US dollar in 2022.

Results: Eight economic evaluations met the study's inclusion criteria. The results of three studies that compared BV plus doxorubicin, vinblastine, and dacarbazine (BV + AVD) front-line therapy with doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD) showed that BV is unlikely to be cost-effective as a front-line treatment in patients advanced stage (III or IV) HL. Four studies investigated the cost-effectiveness of BV in patients with relapsed or refractory (R/R) HL after autologous stem cell transplantation (ASCT). BV was not cost-effective in the reviewed studies at accepted thresholds. In addition, the adjusted ICERs ranged from $65,382 to $374,896 per quality-adjusted life-year (QALY). The key drivers of cost-effectiveness were medication costs, hazard ratio for BV, and utilities.

Conclusion: Available economic evaluations show that using BV as front-line treatment or consolidation therapy is not cost-effective based on specific ICER thresholds for patients with HL or R/R HL. To decide on this orphan drug, we should consider other factors such as existence of alternative treatment options, clinical benefits, and disease burden.

Keywords: Brentuximab vedotin; Economic evaluation; Hodgkin lymphoma; Systematic review.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Bleomycin / therapeutic use
  • Brentuximab Vedotin / therapeutic use
  • Cost-Benefit Analysis
  • Dacarbazine / adverse effects
  • Dacarbazine / therapeutic use
  • Doxorubicin
  • Hematopoietic Stem Cell Transplantation*
  • Hodgkin Disease* / drug therapy
  • Hodgkin Disease* / etiology
  • Humans
  • Transplantation, Autologous
  • Vinblastine / adverse effects
  • Vinblastine / therapeutic use

Substances

  • Brentuximab Vedotin
  • Doxorubicin
  • Bleomycin
  • Vinblastine
  • Dacarbazine