Szabo Shelagh M, Hirji Ishan, Johnston Karissa M, Juarez-Garcia Ariadna, Connors Joseph M
Broadstreet HEOR, Vancouver, British Columbia, Canada.
Bristol-Myers Squibb, Princeton, New Jersey, United States of America.
PLoS One. 2017 Oct 9;12(10):e0180261. doi: 10.1371/journal.pone.0180261. eCollection 2017.
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.
尽管本妥昔单抗（BV）改变了复发或难治性霍奇金淋巴瘤（RRHL）患者的治疗方式，但关于常规临床实践的信息却很少。我们确定了美国接受BV治疗的RRHL患者的治疗模式和护理成本。
对2011年至2015年开始使用BV治疗RRHL的成年人进行了一项回顾性观察研究，收集了BV开始治疗前后至少6个月的数据。治疗根据配药和化疗给药进行分类。中位数总成本和每月成本是根据2015年美元（USD）的全因医疗资源使用情况估算的。
该队列包括289名患者（59%为男性；诊断时的平均年龄为42岁），平均随访250周。11%的患者在自体干细胞移植（ASCT）前接受了BV挽救治疗，32%的患者在ASCT后复发时接受了BV治疗。43%的患者在BV治疗后接受了治疗，最常见的是异基因干细胞移植（SCT）和苯达莫司汀（均为10.2%）。从BV开始治疗到审查的中位数（IQR）总成本为294,790（142,110 - 483,360）美元；在ASCT前接受BV治疗的患者中成本最高（高达421,900 [300,940 - 778,970]美元）。每月中位数成本近20,000美元，在接受BV和ASCT的患者中每月高达25,000美元。药物是每月中位数成本的最大驱动因素。
每位接受治疗的患者的全因中位数总成本近300,000美元，每月中位数成本约20,000美元。BV治疗后仍需治疗的患者继续产生高昂成本，凸显了RRHL患者管理相关的经济负担。
