Brentuximab vedotin in combination with doxorubicin, vinblastine and dacarbazine for first-line treatment of stage IV HL: cost impact on subsequent lines in Italy

Authors

DOI:

https://doi.org/10.33393/ao.2023.2486

Keywords:

Brentuximab vedotin, Cost-analysis, Economic evaluation, Hodgkin lymphoma, Italy

Abstract

Introduction: This study estimates the change in the costs of second-line or later (2L+) treatments compared to the current scenario, associated with the introduction of brentuximab vedotin (Adcetris®) (BV) in combination with doxorubicin, vinblastine and dacarbazine (A+AVD) for the treatment of previously untreated (1L) patients with stage IV classical Hodgkin’s lymphoma (cHL).

Methods: An economic model has been developed that estimates the variation in treatment costs of 2L+ associated with the introduction of BV in 1L from the point of view of the Italian National Health System over a time horizon of 3 years. The population eligible to receive a treatment of 2L+ has been estimated from the literature, considering an increasing consumption in the three years of A+AVD in 1L. Two main scenarios and several alternative scenarios were considered to address the uncertainty that characterizes the distribution of market shares of 2L+ treatments.

Results: In the baseline scenario, over three years, the introduction of BV in 1L is associated with a cumulative reduction in treatment costs of 2L+ of € 1.74 M. In all scenarios, a reduction in treatment costs of 2L+ is confirmed, with a total saving that varies between € 5.6 M and € 1.3 M compared to the main scenarios.

Conclusions: The present analysis shows that the introduction of A+AVD in 1L for the treatment of stage IV CD30+ cHL patients is associated with a reduction in treatment costs of 2L+, even if there are some limitations related to the uncertainty of real cost and population estimates.

References

Opinto G, Agostinelli C, Ciavarella S, Guarini A, Maiorano E, Ingravallo G. Hodgkin Lymphoma: A Special Microenvironment. J Clin Med. 2021;10(20):4665. https://doi.org/10.3390/jcm10204665 PMID:34682791 DOI: https://doi.org/10.3390/jcm10204665

AIRTUM. I numeri del cancro in Italia 2020. 2020. Online https://www.aiom.it/wp-content/uploads/2020/10/2020_Numeri_Cancro-operatori_web.pdf (Accessed July 2022)

Luminari S, Cesaretti M, Rashid I, et al. Incidence, clinical characteristics and survival of malignant lymphomas: a population-based study from a cancer registry in northern Italy. Hematol Oncol. 2007;25(4):189-197. https://doi.org/10.1002/hon.826 PMID:17654762 DOI: https://doi.org/10.1002/hon.826

Brice P, de Kerviler E, Friedberg JW. Classical Hodgkin lymphoma. Lancet. 2021;398(10310):1518-1527. https://doi.org/10.1016/S0140-6736(20)32207-8 PMID:33493434 DOI: https://doi.org/10.1016/S0140-6736(20)32207-8

Associazione Italiana di Oncologia Medica (AIOM). Linee guida. Linfomi; 2018.

Gazzetta Ufficiale della Repubblica Italiana: Serie Generale n.223 del 17-09-2021. Online https://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2021-09-17&atto.codiceRedazionale=21A05437&elenco30giorni=false (Accessed July 2022)

7. Gazzetta Ufficiale della Repubblica Italiana. Online https://www.gazzettaufficiale.it/home (Accessed July 2022)

8. European Medicines Agency (EMA): CHMP post-authorisation summary of positive opinion for Adcetris (II-70). 26 March 2020. Online https://www.ema.europa.eu/en/documents/smop/chmp-post-authorisation-summary-positive-opinion-adcetris-ii-70_en.pdf (Accessed July 2022)

Straus DJ, Długosz-Danecka M, Connors JM, et al. Brentuximab vedotin with chemotherapy for stage III or IV classical Hodgkin lymphoma (ECHELON-1): 5-year update of an international, open-label, randomised, phase 3 trial. Lancet Haematol. 2021;8(6):e410-e421. https://doi.org/10.1016/S2352-3026(21)00102-2 PMID:34048680 DOI: https://doi.org/10.1016/S2352-3026(21)00102-2

Younes A, Bartlett NL, Leonard JP, et al. Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. N Engl J Med. 2010;363(19):1812-1821. https://doi.org/10.1056/NEJMoa1002965 PMID:21047225 DOI: https://doi.org/10.1056/NEJMoa1002965

Connors JM, Jurczak W, Straus DJ, et al; ECHELON-1 Study Group. Brentuximab Vedotin with Chemotherapy for Stage III or IV Hodgkin’s Lymphoma. N Engl J Med. 2018;378(4):331-344. https://doi.org/10.1056/NEJMoa1708984 PMID:29224502 DOI: https://doi.org/10.1056/NEJMoa1708984

Collins GP, Rueda A, Salles G, von Tresckow B, Zaja F. Management of Hodgkin lymphoma in the era of brentuximab vedotin: real-world data from five European countries. Leuk Lymphoma. 2018;59(9):2113-2120. https://doi.org/10.1080/10428194.2017.1421762 PMID:29334819 DOI: https://doi.org/10.1080/10428194.2017.1421762

Esquirol A, Pascual MJ, Garcia-Cadenas I, et al. Combining Three Different Pretransplantation Scores Improves Predictive Value in Patients after Haploidentical Stem Cell Transplantation with Thiotepa, Busulfan, and Fludarabine Conditioning and Post-Transplantation Cyclophosphamide. Transplant Cell Ther. 2021;27(7):614.e1-614.e8. https://doi.org/10.1016/j.jtct.2021.03.021 PMID:33775908 DOI: https://doi.org/10.1016/j.jtct.2021.03.021

Garcia-Sanz R, Sureda A, de la Cruz F, et al. Brentuximab vedotin and ESHAP is highly effective as second-line therapy for Hodgkin lymphoma patients (long-term results of a trial by the Spanish GELTAMO Group). Ann Oncol. 2019;30(4):612-620. https://doi.org/10.1093/annonc/mdz009 PMID:30657848 DOI: https://doi.org/10.1093/annonc/mdz009

Herrera AF, Moskowitz AJ, Bartlett NL, et al. Interim results of brentuximab vedotin in combination with nivolumab in patients with relapsed or refractory Hodgkin lymphoma. Blood. 2018;131(11):1183-1194. https://doi.org/10.1182/blood-2017-10-811224 PMID:29229594 DOI: https://doi.org/10.1182/blood-2017-10-811224

Musso M, Scalone R, Marcacci G, et al. Fotemustine plus etoposide, cytarabine and melphalan (FEAM) as a new conditioning regimen for lymphoma patients undergoing auto-SCT: a multicenter feasibility study. Bone Marrow Transplant. 2010;45(7):1147-1153. https://doi.org/10.1038/bmt.2009.318 PMID:19898504 DOI: https://doi.org/10.1038/bmt.2009.318

Ramos CA, Grover NS, Beaven AW, et al. Anti-CD30 CAR-T Cell Therapy in Relapsed and Refractory Hodgkin Lymphoma. J Clin Oncol. 2020;38(32):3794-3804. https://doi.org/10.1200/JCO.20.01342 PMID:32701411 DOI: https://doi.org/10.1200/JCO.20.01342

Santoro A, Magagnoli M, Spina M, et al. Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin’s lymphoma. Haematologica. 2007;92(1):35-41. https://doi.org/10.3324/haematol.10661 PMID:17229633 DOI: https://doi.org/10.3324/haematol.10661

Santoro A, Mazza R, Pulsoni A, et al. Five-year results of the BEGEV salvage regimen in relapsed/refractory classical Hodgkin lymphoma. Blood Adv. 2020;4(1):136-140. https://doi.org/10.1182/bloodadvances.2019000984 PMID:31935284 DOI: https://doi.org/10.1182/bloodadvances.2019000984

Visani G, Malerba L, Stefani PM, et al. BeEAM (bendamustine, etoposide, cytarabine, melphalan) before autologous stem cell transplantation is safe and effective for resistant/relapsed lymphoma patients. Blood. 2011;118(12):3419-3425. https://doi.org/10.1182/blood-2011-04-351924 PMID:21816830 DOI: https://doi.org/10.1182/blood-2011-04-351924

AIFA. Riassunto delle Caratteristiche del Prodotto. Adcetris. Online https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000712_042448_RCP.pdf&sys=m0b1l3 (Accessed July 2022)

AIFA. Riassunto delle Caratteristiche del Prodotto. Opdivo. Online https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000829_044291_RCP.pdf&sys=m0b1l3 (Accessed July 2022)

Riassunto delle Caratteristiche del Prodotto. Keytruda. Online https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_004815_044386_RCP.pdf&sys=m0b1l3 (Accessed July 2022)

Gazzetta Ufficiale della Repubblica Italiana: GU Serie Generale n.23 del 28-01-2013 – Suppl. Ordinario n. 8 – Allegato I. Online https://www.gazzettaufficiale.it/do/atto/serie_generale/caricaPdf?cdimg=13A0052800100010110001&dgu=2013-01-28&art.dataPubblicazioneGazzetta=2013-01-28&art.codiceRedazionale=13A00528&art.num=1&art.tiposerie=SG (Accessed July 2022)

Gazzetta Ufficiale della Repubblica Italiana: GU Serie Generale n.23 del 28-01-2013. Online https://www.gazzettaufficiale.it/eli/gu/2013/01/28/23/so/8/sg/pdf

Lucioni C, Iannazzo S, Mazzi S, Saporiti G, Chiroli S. Cost-effectiveness of ponatinib in chronic myeloid leukemia in Italy. Glob Reg Health Technol Assess. 2015;1:1-16. https://doi.org/10.33393/grhta.2015.320 DOI: https://doi.org/10.5301/GRHTA.5000189

ISTAT. Rivaluta. Online https://rivaluta.istat.it/?msclkid=1d4790f2d05211ec8ebbac2fe88fdfde (Accessed August 2022)

Tarricone R. Cost-of-illness analysis. What room in health economics? Health Policy. 2006;77(1):51-63. https://doi.org/10.1016/j.healthpol.2005.07.016 PMID:16139925 DOI: https://doi.org/10.1016/j.healthpol.2005.07.016

Palmieri V, Baldi C, Di Blasi PE, et al. Impact of DRG billing system on health budget consumption in percutaneous treatment of mitral valve regurgitation in heart failure. J Med Econ. 2015;18(2):89-95. https://doi.org/10.3111/13696998.2014.980502 PMID:25350644 DOI: https://doi.org/10.3111/13696998.2014.980502

Filetti S, Ladenson PW, Biffoni M, D’Ambrosio MG, Giacomelli L, Lopatriello S. The true cost of thyroid surgery determined by a micro-costing approach. Endocrine. 2017;55(2):519-529. https://doi.org/10.1007/s12020-016-0980-z PMID:27172916 DOI: https://doi.org/10.1007/s12020-016-0980-z

Berto P, Lopatriello S, Aiello A, et al. Cost of laparoscopy and laparotomy in the surgical treatment of colorectal cancer. Surg Endosc. 2012;26(5):1444-1453. https://doi.org/10.1007/s00464-011-2053-y PMID:22179444 DOI: https://doi.org/10.1007/s00464-011-2053-y

Published

2023-01-16

How to Cite

1.
Fiorentino F, Canali B, Morelli P, Demma F. Brentuximab vedotin in combination with doxorubicin, vinblastine and dacarbazine for first-line treatment of stage IV HL: cost impact on subsequent lines in Italy. abtpn [Internet]. 2023 Jan. 16 [cited 2023 Feb. 4];10(1):6-12. Available from: https://journals.aboutscience.eu/index.php/aboutopen/article/view/2486

Issue

Section

Original research article

Categories

Received 2022-08-29
Accepted 2022-12-07
Published 2023-01-16