Economic Burden in US Patients with Relapsed or Refractory Classical Hodgkin Lymphoma Treated with Brentuximab Vedotin or Chemotherapy after Failure of Autologous Hematopoietic Cell Transplantation

Introduction: Classical Hodgkin lymphoma (cHL) is a lymph node cancer of germinal center B-cell origin. Although most patients diagnosed with cHL are cured with multiagent chemotherapy (ChT), those with advanced-stage disease are more likely to harbor refractory disease or relapse. Brentuximab vedotin (BV) was approved by the FDA in 2011 for patients who have relapsed following autologous hematopoietic cell transplantation (auto-HCT), and for patients ineligible for auto-HCT who have received 2 prior lines of therapy. Real-world data are needed to understand the direct costs of medical care among patients with relapsed or refractory cHL treated with BV or ChT after auto-HCT failure.

Methods: US patients with a primary diagnosis of cHL were identified from the Truven MarketScan® databases (Commercial, Medicare, and Medicaid) from August 1, 2011 to June 30, 2016 and followed until last visit. The BV cohort comprised all patients with observed BV use, while the non-BV cohort comprised patients who received ChT after auto-HCT but never received BV. Index therapy was defined as BV-based therapy for the BV cohort and first ChT after auto-HCT failure for the non-BV cohort, and the date of first claim for index therapy was defined as the index date. The BV cohort were further grouped into subcohorts based on any observed receipt of auto-HCT (BV alone vs BV + auto-HCT). Demographics were summarized and descriptively compared between cohorts. The total all-cause costs (inpatient, outpatient, and pharmacy claims) were assessed every 6 months in a 2-year period and also calculated using a standard cost per-patient-per-month (PPPM) metric over the entire follow-up period. All costs were inflated to 2016 US dollars.

Results: 795 HL patients met the study eligibility criteria (mean age: 43.0 years; 58% male); 575 (72%) were in the BV cohort and 220 (28%) in the non-BV cohort. Median follow-up time for the BV and non-BV cohorts was 10.9 and 10.6 months, respectively. Patients in these 2 cohorts were similar in terms of sex and prevalence of multiple cancers (Table), although compared to those in the non-BV cohort, patients on BV were younger on average (mean age: 42.9 vs 45.9 years, p=0.0284). Mean PPPM all-cause medical costs were $51,245 for non-BV and $30,387 for BV. The use of BV was associated with higher mean PPPM all-cause pharmacy costs than non-BV ($17,934 vs $7645), but mean PPPM inpatient and outpatient costs were higher for non-BV than for BV ($35,165 vs $8021 and $8436 vs $4431, respectively).

Within the BV cohort, 357 (62%) received BV alone and 218 (38%) received BV + auto-HCT. Similarly, there was no significant difference in sex and prevalence of multiple cancers between the 2 groups, although those treated with BV + auto-HCT were younger (mean age: 36.0 vs 47.1 years, p<0.0001) and were more likely to be insured with commercial insurance (72% vs 60%, p<0.0001) than those on BV alone. Mean PPPM total all-cause costs were $28,313 for patients treated with BV alone and $33,782 for patients treated with BV + auto-HCT. While mean PPPM pharmacy costs were similar between BV alone and BV + auto-HCT ($18,412 vs $17,152), mean PPPM inpatient and outpatient costs were both higher for BV + auto-HCT than for BV alone ($5992 vs $11,346 and $3909 vs $5285, respectively).

Mean total direct medical costs were calculated at 6, 12, 18, and 24 months from index date for those with available follow-up over the corresponding time period. Costs were consistently higher for non-BV and BV + auto-HCT relative to BV alone. At 24 months, mean total all-cause costs reached $550,000 for non-BV, $497,000 for BV + auto-HCT, and $379,000 for BV alone. Inpatient, outpatient, and pharmacy represent approximately 69%, 16%, and 15% of total all-cause costs for non-BV; 34%, 16%, and 51% for BV + auto-HCT; and 21%, 14%, and 65% for BV alone. These patterns were relatively consistent across all 4 timepoints considered (Table).

Conclusions: While drug acquisition costs result in higher pharmacy costs for patients receiving newer agents, lower medical costs (including costs of inpatient and outpatient care for the management of cHL, cHL-related events, and other clinical conditions) may be associated with the use of newer efficacious therapies with potentially lower toxicity; thus, the use of newer agents may lead to overall cost savings.

Study support: Bristol-Myers Squibb.

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