Brentuximab vedotin + AVD in cHL: cost impact on adverse events, toxicity, second malignancies, end-of-life and subsequent lines of therapy in Italy

Introduction: In classical Hodgkin lymphoma (cHL), the delayed effects of therapies, such as second malignancies and toxicity, and the high relapse rate are potentially associated with an expense for the National Health Service (NHS). Objective: The objective of the study was to estimate the impact of introducing the combination of brentuximab vedotin (Adcetris®), doxorubicin, vinblastine and dacarbazine (A+AVD) for the first line (1L) treatment of stage III/IV cHL on costs associated with adverse events (AEs), pulmonary toxicity, second malignancies, end-of-life and second and subsequent lines (2L+) treatments. Method: The incidence of the events analysed was derived from clinical trials and Italian reports. Unit costs were estimated based on the national tariffs and the Italian literature. The results were modelled and extrapolated to the population in two scenarios, a current one without A+AVD and a future one in which A+AVD is introduced. The time horizon was six years and the perspective is that of the Italian NHS. Results: The introduction of A+AVD in 1L is associated with a reduction in the costs of AEs, pulmonary toxicity, second malignancies and end-of-life following 1L and in the acquisition costs of 2L+ treatments of approximately € 10,400/patient corresponding to a total saving of € 18.46 M over six years for the NHS; this saving grows as the use of A+AVD increases. Conclusion: The introduction of A+AVD for the 1L treatment of stage III/IV cHL is associated with a reduction in costs for the NHS for the management of AEs, pulmonary toxicity, second malignancies, end-of-life and 2L+ treatments.