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Xie S, Sheng Y, Chuang LH, Wu J. Cost-effectiveness of brentuximab vedotin compared with conventional chemotherapy for relapsed or refractory classic Hodgkin lymphoma in China. HEALTH ECONOMICS REVIEW 2024; 14:38. [PMID: 38842725 PMCID: PMC11155000 DOI: 10.1186/s13561-024-00514-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Relapsed or refractory classic Hodgkin lymphoma (RRcHL) associates with poor prognosis and heavy disease burden to patients. This study evaluated the cost-effectiveness of brentuximab vedotin (BV) in comparison to conventional chemotherapy in patients with RRcHL, from a Chinese healthcare perspective. METHODS The lifetime cost and quality adjusted life years (QALYs) were estimated through a partitioned survival model with three health states (progression free, post progression, and death). Two cohorts for each BV arm and chemotherapy arm were built, representing patients with and without transplant after BV or chemotherapy, respectively. Clinical parameters were retrieved from BV trials and the literature. Resource utilization data were mainly collected from local expert surveys and cost parameters were reflecting local unit prices. Utility values were sourced from the literature. A discount rate of 5% was employed according to the Chinese guideline. A series of deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness and uncertainty associated with the model. RESULTS Results of the base case analysis showed that the incremental cost-effectiveness ratio (ICER) for BV versus chemotherapy was $2,867 (¥19,774). The main model driver was the superior progression-free and overall survival benefits of BV. The ICERs were relatively robust in a series of sensitivity analyses, all under a conventional decision threshold (1 time of Chinese per capita GDP). With this conventional threshold, the probability of BV being cost-effective was 100%. CONCLUSIONS Brentuximab vedotin can be considered a cost-effective treatment versus conventional chemotherapy in treating relapsed or refractory classic Hodgkin lymphoma in China.
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Affiliation(s)
- Shitong Xie
- School of Pharmaceutical Science and Technology, Faculty of Medicine, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Yanan Sheng
- Medical Affairs, Takeda (China) International Trading Company, Beijing, China
| | | | - Jing Wu
- School of Pharmaceutical Science and Technology, Faculty of Medicine, Tianjin University, Tianjin, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
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Bröckelmann PJ, Müller H, Guhl T, Behringer K, Fuchs M, Moccia AA, Rank A, Soekler M, Vieler T, Pabst T, Baues C, von Tresckow B, Borchmann P, Engert A. Relapse After Early-Stage, Favorable Hodgkin Lymphoma: Disease Characteristics and Outcomes With Conventional or High-Dose Chemotherapy. J Clin Oncol 2020; 39:107-115. [PMID: 33058716 DOI: 10.1200/jco.20.00947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We evaluated disease and treatment characteristics of patients with relapse after risk-adapted first-line treatment of early-stage, favorable, classic Hodgkin lymphoma (ES-HL). We compared second-line therapy with high-dose chemotherapy and autologous stem cell transplantation (ASCT) or conventional chemotherapy (CTx). METHODS We analyzed patients with relapse after ES-HL treated within the German Hodgkin Study Group HD10+HD13 trials. We compared, by Cox proportional hazards regression, progression-free survival (PFS) after relapse (second PFS) treated with either ASCT or CTx and performed sensitivity analyses with overall survival (OS) from relapse and Kaplan-Meier statistics. RESULTS A total of 174 patients' disease relapsed after treatment in the HD10 (n = 53) and HD13 (n = 121) trials. Relapse mostly occurred > 12 months after first diagnosis, predominantly with stage I-II disease. Of 172 patients with known second-line therapy, 85 received CTx (49%); 70, ASCT (41%); 11, radiotherapy only (6%); and 4, palliative single agent therapies (2%). CTx was predominantly bleomycin, etoposide, doxorubicin cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [68%]), followed by the combination regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (19%), or other regimens (13%). Patients aged > 60 years at relapse had shorter second PFS (hazard ratio [HR], 3.0; P = .0029) and were mostly treated with CTx (n = 33 of 49; 67%) and rarely with ASCT (n = 8; 16%). After adjustment for age and a disadvantage of ASCT after the more historic HD10 trial, we did not observe a significant difference in the efficacy of CTx versus ASCT for second PFS (HR, 0.7; 95% CI, 0.3 to 1.6; P = .39). In patients in the HD13 trial who were aged ≤ 60 years, the 2-year, second PFS rate was 94.0% with CTx (95% CI, 85.7% to 100%) versus 83.3% with ASCT (95% CI, 71.8% to 94.8%). Additional sensitivity analyses including OS confirmed these observations. CONCLUSION After contemporary treatment of ES-HL, relapse mostly occurred > 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after ES-HL.
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Affiliation(s)
- Paul J Bröckelmann
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Horst Müller
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Teresa Guhl
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Karolin Behringer
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Michael Fuchs
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Alden A Moccia
- Swiss Group for Clinical Cancer Research, Bern, Switzerland.,Department of Internal Medicine II, University Hospital Tuebingen, Tuebingen, Germany
| | - Andreas Rank
- Department of Hematology and Oncology, University Hospital of Augsburg, Augsburg, Germany
| | - Martin Soekler
- Department of Internal Medicine II, University Hospital Tuebingen, Tuebingen, Germany
| | - Tom Vieler
- University Hospital Schleswig-Holstein, Karl Lennert-Cancer Center, Kiel, Germany
| | - Thomas Pabst
- Swiss Group for Clinical Cancer Research, Bern, Switzerland.,Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Christian Baues
- Department of Radiooncology and Cyberknife Center, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - Andreas Engert
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD) and German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
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Rusconi C, Ciavarella S, Fabbri A, Flenghi L, Puccini B, Re A, Sorio M, Vanazzi A, Zanni M. Treatment of very high-risk classical Hodgkin Lymphoma: cases' selection from real life and critical review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:13-22. [PMID: 32525130 PMCID: PMC7944652 DOI: 10.23750/abm.v91is-5.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
Over the last 4 decades, advances in radiation therapy and the addition of combination chemotherapy have significantly increased the cure rate of patients with HL, with a 5-year OS of about 90% . However, despite high rate of cure after first line of therapy, 5%-10% of HLs are refractory to the treatment, and 10-30% of patients have a disease relapse after a complete response (CR). Relapsed HL can be treated with salvage therapies with a long-lasting complete remission in 80% of cases. In recent years, novel drugs are available for the patients with relapsed/refractory HL, like Brentuximab Vedotin and immune checkpoint inhibitors. These drugs have been able to rescue a cohort of patients who subsequently could receive an allogeneic stem-cell transplant. Our cases have been chosen because they are representative of critical issues in the management of relapsed/refractory HL; our experiences are consistent with what reported by other Authors.
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Affiliation(s)
- Chiara Rusconi
- Division of Haematology, Department of Haematology and Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano.
| | - Sabino Ciavarella
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy.
| | | | - Benedetta Puccini
- Haematology Unit, Careggi Hospital-University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alessandro Re
- Department of Hematology, ASST Spedali Civili di Brescia, Italy.
| | - Marco Sorio
- Department of Clinical and Experimental Medicine, Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy.
| | - Anna Vanazzi
- Division of Clinical Hemato-Oncology, Istituto Europeo di Oncologia, Milan, Italy.
| | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
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Parker C, Woods B, Eaton J, Ma E, Selby R, Benson E, Engstrom A, Sajosi P, Briggs A, Bonthapally V. Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma post-autologous stem cell transplant: a cost-effectiveness analysis in Scotland. J Med Econ 2017; 20:8-18. [PMID: 27472034 DOI: 10.1080/13696998.2016.1219358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate cost-effectiveness of brentuximab vedotin in patients with relapsed/refractory Hodgkin lymphoma who have received autologous stem cell transplantation, from a Scottish healthcare payer perspective. METHODS A Microsoft Excel-based partitioned survival model comprising three health states (progression-free survival [PFS], post-progression survival, and death) was developed. Relevant comparators were chemotherapy with or without radiotherapy (C/R) and C/R with intent to allogeneic hematopoietic stem cell transplantation (alloSCT). Data were obtained from the pivotal phase II single-arm trial in 102 patients (SG035-0003; NCT00848926), a systematic literature review and clinical expert opinions (where empirical evidence was unavailable). PFS and overall survival for brentuximab vedotin were estimated using 5-year follow-up data from SG035-0003, and extrapolated using event rates observed for comparator treatments from published survival data. Resource use included drug acquisition and administration; alloSCT; treatment of adverse events; and long-term follow-up. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the impact of uncertainty. RESULTS In the base case, the incremental cost-effectiveness ratio (ICER) for brentuximab vedotin was £38,769 per quality-adjusted life year (QALY) vs C/R, whereas C/R with intent to alloSCT was dominated by brentuximab vedotin. ICERs for brentuximab vedotin generated by the deterministic sensitivity analysis ranged between £32,000-£54,000 per QALY. Including productivity benefits reduced the ICER to £28,881 per QALY. LIMITATIONS Limitations include lack of comparative data from this single arm study and the heterogeneous population. Inconsistent baseline characteristic reporting across studies prevented complete assessment of heterogeneity and the extent of potential bias in clinical and cost-effectiveness estimates. CONCLUSIONS Although the base case ICER is above the threshold usually applied in Scotland, it is relatively low compared with other orphan drugs, and lower than the ICER generated using a previous data cut of SG035-0003 that informed a positive recommendation from the Scottish Medicines Consortium, under its decision-making framework for assessment of ultra-orphan medicines.
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Affiliation(s)
| | - Beth Woods
- b Centre for Health Economics, University of York , York , UK
| | - James Eaton
- a ICON Health Economics & Epidemiology , Abingdon , UK
| | - Esprit Ma
- c Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center , Boston , MA , USA
| | | | | | | | - Peter Sajosi
- f Millennium Pharmaceuticals Inc. , Cambridge , MA , USA ,a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Andrew Briggs
- a ICON Health Economics & Epidemiology , Abingdon , UK
- g Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK
| | - Vijayveer Bonthapally
- f Millennium Pharmaceuticals Inc. , Cambridge , MA , USA ,a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
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Van Den Neste E, Casasnovas O, André M, Touati M, Senecal D, Edeline V, Stamatoullas A, Fornecker L, Deau B, Gastinne T, Reman O, Gaillard I, Borel C, Brice P, Fermé C. Classical Hodgkin's lymphoma: the Lymphoma Study Association guidelines for relapsed and refractory adult patients eligible for transplant. Haematologica 2014; 98:1185-95. [PMID: 23904236 DOI: 10.3324/haematol.2012.072090] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The Hodgkin's Lymphoma Committee of the Lymphoma Study Association (LYSA) gathered in 2012 to prepare guidelines on the management of transplant-eligible patients with relapsing or refractory Hodgkin's lymphoma. The working group is made up of a multidisciplinary panel of experts with a significant background in Hodgkin's lymphoma. Each member of the panel of experts provided an interpretation of the evidence and a systematic approach to obtain consensus was used. Grades of recommendation were not required since levels of evidence are mainly based on phase II trials or standard practice. Data arising from randomized trials are emphasized. The final version was endorsed by the scientific council of the LYSA. The expert panel recommends a risk-adapted strategy (conventional treatment, or single/double transplantation and/or radiotherapy) based on three risk factors at progression (primary refractory disease, remission duration < 1 year, stage III/IV), and an early evaluation of salvage chemosensitivity, including (18)fluorodeoxy glucose-positron emission tomography interpreted according to the Deauville scoring system. Most relapsed or refractory Hodgkin's lymphoma patients chemosensitive to salvage should receive high-dose therapy and autologous stem-cell transplantation as standard. Efforts should be made to increase the proportion of chemosensitive patients by alternating non-cross-resistant chemotherapy lines or exploring the role of novel drugs.
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Gobbi PG, Ferreri AJ, Ponzoni M, Levis A. Hodgkin lymphoma. Crit Rev Oncol Hematol 2013; 85:216-37. [DOI: 10.1016/j.critrevonc.2012.07.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 03/02/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022] Open
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Abstract
Management of Hodgkin's lymphoma continues to develop. Outcomes for patients with favourable-risk, early-stage disease are excellent, and serial reductions in intensity of treatment have been made to retain the excellent prognosis while reducing the late effects of treatment. Prognosis is also very good in advanced-stage disease but the rate of relapse is higher than in early-stage disease, and the optimum first-line treatment is unclear. Workers are investigating the role of functional imaging to assess whether treatment can be tailored according to response, with the most intensive therapies reserved for patients predicted to have poor outcomes. In this Seminar we critically appraise the management of Hodgkin's lymphoma in early-stage disease, advanced-stage disease, and at relapse, with a focus on late effects of treatment.
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Affiliation(s)
- William Townsend
- Department of Haematology, University College London Medical School, Cancer Institute, UK
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8
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Ortín X, Rodríguez-Luaces M, Bosch R, Lejeune M, Font L. Acute liver failure as the first manifestation of very late relapsing of Hodgkin's disease. Hematol Rep 2010; 2:e5. [PMID: 22184518 PMCID: PMC3222269 DOI: 10.4081/hr.2010.e5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 07/15/2010] [Accepted: 07/15/2010] [Indexed: 12/13/2022] Open
Abstract
Hodgkin's disease is, in general, a lymph node-based disease. It usually starts in an area within the lymphatic system and spreads, in an orderly manner, along the lymphatic chain to contiguous lymph node areas. There have been sporadic case reports of acute liver failure caused by hematological malignancies. Generally, liver failure is a feature of stage IV end-stage disease, when it occurs in lymphoma. Thus, hepatic involvement usually occurs late in the course of Hodgkin's disease or with advanced-stage disease, and primary presentation in the liver with acute liver failure is extremely rare. In most cases, the diagnosis was made at autopsy. We describe a patient with Hodgkin's disease presenting with acute liver failure. This is a very unusual Hodgkin's disease form of presentation, because the acute liver failure was the presenting feature of the disease. Furthermore, the lymphoma occurred as a very late relapse, twenty years after the first diagnosis. To the best of our knowledge, such a case has not been described to date.
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Affiliation(s)
- Xavier Ortín
- Servicio de Hematología, Hospital de Tortosa Verge de la Cinta, Tortosa, Spain
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Fesler MJ, Nguyen NC, Petruska PJ. Modified escalated BEACOPP as salvage chemotherapy in classic Hodgkin lymphoma. Int J Hematol 2010; 92:211-3. [DOI: 10.1007/s12185-010-0630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/15/2010] [Accepted: 06/06/2010] [Indexed: 10/19/2022]
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Eichenauer DA, Engert A. Is there a role for BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone) in relapsed Hodgkin lymphoma? Leuk Lymphoma 2010; 50:1733-4. [PMID: 19883301 DOI: 10.3109/10428190903308098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
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