Pharmacoeconomic analysis of therapy with brentuximab vedotin, nivolumab and pembrolizumab in patients with relapsed Hodgkin’s lymphoma

Abstract

Background. In the Russian Federation, in 2018 3,207 new cases of Hodgkin’s lymphoma (HL) were detected, mainly in adults. Despite significant advances in the treatment of this disease, approximately 20–30 % of patients develop relapses. High-dose chemotherapy with autologous hematopoietic stem cell transplantation is the standard 2nd line therapy. Patients with relapse after autologous hematopoietic stem cell transplantation have a poor prognosis. Brentuximab vedotin, nivolumab, and pembrolizumab are indicated for treatment of relapsed HL after autologous stem cell transplantation.The objective of this study is to conduct budget impact analysis of increasing the share of patients with relapsed HL, who are treated with brentuximab vedotin.Materials and methods. We estimated medication costs of using brentuximab vedotin, nivolumab, and pembrolizumab based on clinical trials data. The number of patients who annually start treatment using these alternatives was determined using data on purchases of drugs by public health funds in 2019. Budget impact was defined as the difference in public health expenditures on medications in case of increase in brentuximab vedotin share by 10 or 20 percentage points compared to current practice, with a proportional decrease in the share of patients, who receive nivolumab or pembrolizumab. Time horizon was 6 years.Results. Expenses for treatment of a single patient with relapsed HL within 6-year study horizon using brentuximab vedotin (7.07 million rubles) were 2.15 million rubles less than in case of treatment with nivolumab, and 4.38 million rubles less than for pembrolizumab. There are 295 patients with relapsed HL, who start treatment with brentuximab vedotin, nivolumab or pembrolizumab annually. If the proportion of patients, who start therapy using brentuximab vedotin, increases from the current 60 % to 70 %, cost savings over 6 years will be 171 million rubles, which corresponds to extra 24 patients who can be treated using brentuximab vedotin without increasing budget expenditures. If the proportion of patients with relapsed HL receiving brentuximab vedotin increases to 80 %, savings in public health funds over 6 years will amount to 341 million rubles, which allows treating 48 additional patients with brentuximab vedotin without budget increase.Conclusion. Brentuximab vedotin is a cost-saving treatment option of relapsed HL, compared to nivolumab and pembrolizumab. Increasing share of patients, who receive brentuximab vedotin, allows treating additional patients without increase in public health budget.