Abstract P027

Cost-effectiveness analysis of N-AVD vs BrECADD in advanced-stage classic Hodgkin lymphoma

Background: Recent trials have established Nivolumab(N)-AVD and BrECADD as parallel standards in advanced-stage classic Hodgkin lymphoma (cHL). Many factors influence the choice of frontline regimen, including comorbidities, stage, toxicities, and reimbursement decisions. We compared the cost-effectiveness of the two strategies from a US payer perspective over a lifetime horizon.

Methods: A 5-state Markov model was developed: progression-free after first-line therapy (PF1), salvage therapy +/- ASCT for first progression (PD1), progression-free after salvage and ASCT (PF2), second progression (PD2), and death. Patients who relapsed after N-AVD were assumed to receive Brentuximab-based salvage, while patients who relapsed after BrECADD were assumed to receive Pembrolizumab-based salvage. Costs and utilities were discounted at 3% annually. Transition probabilities were derived from digitized and extrapolated survival curves. Main outcomes were incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB). Sensitivity analyses were performed to test the validity of the base case conclusions.

Results: In the base case, BrECADD increased discounted quality-adjusted life years (QALYs) by 0.50 and life-years by 0.36 at an incremental cost of $39,307, yielding an ICER of $79,298/QALY and an INMB of $35,046 at a willingness-to-pay (WTP) threshold of $150,000/QALY. In probabilistic sensitivity analysis (10,000 simulations), the ratio-of-means ICER was $84,241/QALY, and the probability that BrECADD was cost-effective was 74.3% at a WTP of $150,000/QALY. In one-way sensitivity analyses, the base case conclusion was most sensitive to varying frontline regimen efficacy, frontline costs, and the time horizon. In two-way sensitivity analyses, BrECADD was no longer preferred when N-AVD 5-year PFS was increased to 91.3%, when BrECADD drug costs were increased by 125%, or when the time horizon was shortened to 26 years. In a structural sensitivity analysis assigning Pembrolizumab-based salvage after both N-AVD and BrECADD, the ICER for BrECADD rose to $176,019/QALY.

Conclusion: BrECADD was cost-effective compared with N-AVD at a WTP threshold of $150,000/QALY. This finding remained consistent across most deterministic and probability sensitivity analyses.