Date Published: October 9, 2017
Publisher: Public Library of Science
Author(s): Shelagh M. Szabo, Ishan Hirji, Karissa M. Johnston, Ariadna Juarez-Garcia, Joseph M. Connors, Graciela Andrei.
Although brentuximab vedotin (BV) has changed the management of patients with relapsed or refractory Hodgkin lymphoma (RRHL), little information is available on routine clinical practice. We identified treatment patterns and costs of care among RRHL patients in the United States (US) treated with BV.
A retrospective observational study of adults initiating BV for RRHL from 2011–2015, with ≥6 months of data prior to and following BV initiation, was conducted. Treatments were classified based on dispensations and chemotherapy administration. Median total and monthly costs were estimated based on all-cause healthcare resource use in 2015 US dollars (USD).
The cohort comprised 289 patients (59% male; mean age at diagnosis, 42 years) with a mean follow-up of 250 weeks. Eleven percent had BV salvage therapy prior to ASCT, and 32% had BV for a relapse post-ASCT. 43% received treatment post-BV, most commonly allogeneic stem cell transplant (SCT) and bendamustine (both 10.2%). Median (IQR) total costs from BV initiation to censoring were 294,790 (142,110–483,360) USD; and were highest among those treated with BV prior to ASCT (up to 421,900 [300,940–778,970] USD). Median monthly costs were almost 20,000 USD per month, and up to 25,000 USD per month among those with BV and ASCT. Medications were the greatest driver of median monthly costs.
Median total all-cause costs were almost 300,000 USD, and median monthly costs approximately 20,000 USD, per patient treated. Patients requiring treatment following BV continue to incur high costs, highlighting the economic burden associated with managing patients in the RRHL setting.
Hodgkin lymphoma (HL) is a neoplasm of the lymphatic system. In the early stages, individuals afflicted are typically asymptomatic and present with enlarged or hardened lymph nodes, commonly in the cervical and supraclavicular regions.[1, 2] When diagnosed early, while the cancer is still localized, the prognosis of HL tends to be very favorable.[1, 3] Most patients with HL can be cured with first-line multi-agent chemotherapy, with or without radiation; however, a substantial proportion—approximately 10–20%—develop progressive disease despite primary treatment, and require second-line therapy. Of these patients, approximately 50% will be cured, most often with high-dose chemotherapy plus autologous stem cell transplant (ASCT).[4–6] While treatment options for the relatively small population of patients with HL who experience a relapse or are refractory after ASCT were historically quite limited, recent advances are providing new hope for improved outcomes.
Of 666 patients who were ever treated with BV, 122 were excluded for anaplastic large cell lymphoma. Of the remaining 544, 289 had ≥6 months of enrollment data before and after BV initiation, and were therefore eligible for inclusion in the cohort. The mean (SD) age at diagnosis was 42.3 (17.2) years, 58.5% were male, and 66.8% had coverage under commercial insurance plans (Table 1). Of the 289 patients, 33 (11.4%) had BV salvage prior to ASCT, 91 (31.5%) had BV post-ASCT relapse, and 156 (54.0%) had BV without an observed ASCT; as only 1 (0.3%) had BV maintenance therapy after ASCT, and 8 (2.8%) had BV in the line prior to ASCT, results for these subgroups should be interpreted with caution. Patients who had ever received BV and ASCT tended to be younger (mean age, 35.9 years vs. 47.8 years for those who were never observed to receive ASCT) and were more likely to have commercial insurance (73.7% vs. 60.9% for those who were never observed to have received ASCT).
In this study using US administrative claims data, treatment patterns and health resource utilization among the subpopulation of patients with classical HL treated with BV for RRHL, were characterized. Members of the core cohort were required to have ≥6 months of enrollment before and after BV initiation, to increase the likelihood of observing key treatments and outcomes of interest. On average, patients had over 250 weeks of data available for analysis; including 180 weeks prior to BV initiation and almost 50 weeks after BV discontinuation. Eighty-four percent had a record of a prior HL therapy before BV, and BV was most frequently observed to be administered within the second and third lines of therapy. Eleven percent were observed to have BV therapy prior to ASCT, and 32% had BV therapy after a relapse of ASCT; only one patient was observed with BV maintenance therapy in the same line but after ASCT. Finally, 43% went on to a subsequent line of therapy after treatment with BV and/or ASCT; which were most frequently therapy with bendamustine or allo-SCT, across treatment groups.