Cost Effectiveness of Nivolumab for the Treatment of Relapsed/Refractory Classical Hodgkin Lymphoma (cHL) after Failure of Autologous Stem Cell Transplantation (ASCT) and Treatment with Brentuximab Vedotin (BV) Treatment in Australia

Introduction

Australian cHL patients who have failed ASCT and BV treatment have historically had poor outcomes; however, recent clinical trial evidence has shown promising efficacy for nivolumab, a cancer immunotherapy that breaks the tolerance of the immune system to tumour cells and antigens by modulating the programmed death-1 (PD-1) regulatory checkpoint of the immune system. This study presents a cost effectiveness analysis of nivolumab compared to standard of care (SoC) in a contemporary Australian setting.

Methods

A life-time decision-analytic partitioned survival model was developed to compare nivolumab with SoC. The comparison was performed in multiple steps as no head to head data were available. Step 1 estimated costs and outcomes for SoC using pooled data from British Columbia Cancer Agency Lymphoid Cancer Database and pseudo-individual patient data (IPD) simulated from a study published by Cheah et al. Ann. Oncol. 2016 on patients with cHL who had received BV treatment. Quality of life (QoL) was sourced from the literature. Step 2 estimated costs and outcomes (incl. QoL) for nivolumab based on pooled IPD from two clinical trials (Phase II study CheckMate205 and Phase I study CheckMate039). Australian specific costs were applied in both scenarios and expressed in US dollars (US$). Outcomes were extrapolated beyond the clinical trial data by applying parametric functions over a lifetime horizon. In Step 3 the incremental cost effectiveness ratio (ICER) was estimated for life years (LY) and quality adjusted life years (QALY) utilizing the results from Step 1 and 2. Sensitivity analyses were undertaken to test the robustness of the results of the model.

Results

Nivolumab resulted in more than double the survival from 3.8 LYs to 8.6 LYs when compared to SoC and added 4.5 quality adjusted life years (QALYs) per person at an additional cost of US$214k (discounted). These led to ICERs of US$47k per LY gained and US$45k per QALY gained. Sensitivity analyses showed that the result was most sensitive to the time horizon, duration of treatment and health state utilities. However, the ICER was stable and generally stayed within +/-10% of the base case for most of the scenarios tested.

Conclusions

Nivolumab represents a cost-effective alternative to current SoC, with potential to improve quality of life and survival for patients treated for relapsed/refractory cHL after failure of ASCT and BV in Australia.