WHAT IS THE CADTH REIMBURSEMENT RECOMMENDATION FOR ADCETRIS?: CADTH recommends that Adcetris be reimbursed by public drug plans for the treatment of patients with previously untreated advanced stage Hodgkin lymphoma (HL) if certain conditions are met. WHICH PATIENTS ARE ELIGIBLE FOR COVERAGE? Adcetris should only be covered to treat adults aged 18 years or older with advanced stage classical HL or children and adolescents aged 2 years or older with high-risk HL who are in relatively good health. Adcetris should not be covered to treat patients with nodular lymphocyte-predominant HL, severe sensory or motor peripheral neuropathy, cerebral or meningeal disease, or a neurologic disease that affects their daily activities. WHAT ARE THE CONDITIONS FOR REIMBURSEMENT? Adcetris should only be reimbursed if it is prescribed by a clinician with experience treating HL and its cost is reduced. In the pediatric population, the prescribing clinician should also have expertise in pediatric oncology. Brentuximab vedotin (BV) should be used in combination with doxorubicin (Adriamycin), vinblastine, and dacarbazine (AVD) in adults or doxorubicin (Adriamycin), vincristine, etoposide, prednisone, and cyclophosphamide (AVEPC) in pediatric patients. WHY DID CADTH MAKE THIS RECOMMENDATION? Evidence from a clinical trial demonstrated that Adcetris plus AVD was better than doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD) in delaying disease progression and prolonging survival in adults with previously untreated advanced stage (Ann Arbor stage III and IV) classical HL. Evidence from another clinical trial demonstrated that Adcetris plus AVEPC was better than doxorubicin (Adriamycin), bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) in delaying disease progression or relapse, second malignancy, or death in patients aged 2 years or older and younger than 22 years with high-risk classical HL. Patients need new treatments for HL that control symptoms, prolong remission, prolong survival, and improve quality of life. In addition, there is a need to avoid further therapies and late effects in the pediatric population. Adcetris meets some of these needs because it prolongs disease remission, prolongs survival, and may delay the need for further therapies. Based on CADTH’s assessment of the health economic evidence in a population of adults with previously untreated advanced stage HL, Adcetris does not represent good value to the health care system at the public list price. A price reduction is therefore required. As no health economic information was submitted on the use of Adcetris in pediatric patients with advanced stage HL, the cost-effectiveness of Adcetris in this population is unknown. Based on public list prices, Adcetris is estimated to cost the public drug plans approximately $35 million over the next 3 years. However, the budget impact is uncertain because pediatric patients were assumed to receive the same chemotherapy backbone and comparator treatment as adults, which is contradictory to the feedback provided by the clinical experts consulted for this review.
WHAT IS HL? HL is a type of blood cancer that originates from white blood cells called lymphocytes. In 2022, an estimated 1,050 new cases of HL occurred in Canada overall. In 2019, 25 children in Canada aged 0 to 14 years were diagnosed with HL. UNMET NEEDS IN HL: Patients need new treatments for HL that control disease symptoms, prolong remission, prolong survival, and improve quality of life. HOW MUCH DOES ADCETRIS COST? In the adult population, treatment with Adcetris plus AVD is expected to cost approximately $21,584 per patient per 28 days. In the pediatric population, treatment with Adcetris plus AVEPC is expected to cost approximately $21,110 per patient per 28 days, depending on patient weight and body surface area.
