title: Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma post-autologous stem cell transplant: a cost-effectiveness analysis in Scotland.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a ICON Health Economics & Epidemiology , Abingdon , UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Parker
authors.affiliation: b Centre for Health Economics, University of York , York , UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Woods
authors.affiliation: a ICON Health Economics & Epidemiology , Abingdon , UK.
authors.forename: James
authors.initials: J
authors.lastname: Eaton
authors.affiliation: 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.
authors.forename: Esprit
authors.initials: E
authors.lastname: Ma
authors.affiliation: d Takeda UK Ltd , Buckinghamshire , UK.
authors.forename: Ross
authors.initials: R
authors.lastname: Selby
authors.affiliation: d Takeda UK Ltd , Buckinghamshire , UK.
authors.forename: Eugene
authors.initials: E
authors.lastname: Benson
authors.affiliation: e Takeda Pharma AB , Stockholm , Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Engstrom
authors.affiliation: f Millennium Pharmaceuticals Inc. , Cambridge , MA , USA ,a wholly owned subsidiary of Takeda Pharmaceutical Company Limited.
authors.forename: Peter
authors.initials: P
authors.lastname: Sajosi
authors.affiliation: a ICON Health Economics & Epidemiology , Abingdon , UK.|g Institute of Health and Wellbeing, University of Glasgow , Glasgow , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Briggs
authors.affiliation: f Millennium Pharmaceuticals Inc. , Cambridge , MA , USA ,a wholly owned subsidiary of Takeda Pharmaceutical Company Limited.
authors.forename: Vijayveer
authors.initials: V
authors.lastname: Bonthapally
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000079963:Brentuximab Vedotin; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000601:surgery*; D006801:Humans; D018796:Immunoconjugates / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012606:Scotland; D055502:Secondary Prevention; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous / Q000191:economics*; D055815:Young Adult
chemical_list: D018796:Immunoconjugates; D000079963:Brentuximab Vedotin
keywords: Decision analysis; Health technology assessment; Health utility; Orphan medicine; Quality-adjusted life year