Cost-effective options for haematological cancers investigated at ISPOR
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Cost-effective options for haematological cancers investigated at ISPOR – Val McMahon – New monoclonal antibody therapies are becoming available for the treatment of haematological cancers. Several studies presented at the 23rd Annual European Congress of the International Society for Pharmacoeconomics and Outcomes Research in November 2020, which was held as a virtual conference (Virtual ISPOR Europe 2020), investigated the cost effectiveness or budget impact of monoclonal antibodies for haematological cancers.
Brentuximab vedotin
Inotuzumab ozogamicin
Brentuximab vedotin (BV) plus cyclophosphamide, doxorubicin and prednisone (CHP) appears to be cost effective compared with vincristine plus CHP (CHOP) for first-line treatment of systemic anaplastic large cell lymphoma (sALCL) in the UK, according to findings of a Takeda-funded analysis of data from the ECHELON-2 study.1 A three-state partitioned survival model was used to evaluate the cost effectiveness of BV plus CHP versus CHOP in patients with sALCL, from a UK National Health Service (NHS) perspective. The unadjusted hazard ratio for overall survival with BV plus CHP compared with CHOP was 0.54 (95% CI 0.34, 0.87; p=0.01). Based on two-stage estimator analysis, the estimated incremental cost-effectiveness ratio (ICER) for BV plus CHP versus CHOP was £27 096 per QALY gained when retreatment was included and £23 345 per QALY gained when retreatment was excluded. BV plus CHP has been recently approved by Health Canada for previously untreated CD30-expressiong sALCL, peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) and angioimmunoblastic T-cell lymphoma (AITL), based on data from the ECHELON-2 study. In a second study presented at ISPOR, investigators used a partitioned survival model to evaluate the cost effectiveness of BV + CHP versus CHOP in adults with CD30-expressing sALCL, PTCLNOS or AITL, in a Canadian setting over a lifetime time horizon.2 BV plus CHP was associated with an incremental gain of 2.38 QALYs versus CHOP, at an incremental cost of $76 491 [Canadian dollars], resulting in an ICER of $32 177 per QALY gained. BV + CHP is cost effective compared with CHOP for first-line treatment of CD30-expressing sALCL, PTCL-NOS or AITL in Canada, concluded the authors.
Inotuzumab ozogamicin (InO) appears to be cost effective in patients with relapsed or refractory acute lymphoblastic leukaemia (rrALL), according to findings of another Pfizer-funded cost-utility analysis.4 A partitioned survival model was used to evaluate the cost effectiveness of InO compared with standard of care (SoC) and blinatumomab in patients with Philadelphia chromosome-negative (Ph–) rrALL in the Netherlands, over a lifetime time horizon. InO was estimated to achieve incremental gain of 2.2 QALYs per patient compared with SoC, at an incremental cost of €102 138, resulting in an ICER of €46 946 per QALY gained, which was well below the willingness-to-pay threshold in the Netherlands (€80 000 per QALY gained). InO was dominant (more effective and less costly) compared with
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