High Unmet Need in Hodgkin’s Disease Warrants High Price for Adcetris®
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| Sep 8, 2011
The recently released price for Adcetris® (brentuximab vedotin, Seattle Genetics/Takeda), now approved for third-line Hodgkin’s Disease (HD) and second-line anaplastic large cell lymphoma (ALCL) has gotten a lot of attention in light of the high cost of Provenge® (sipuleucel-T, Dendreon) and that drug’s underperformance compared to expectations. While Provenge is a cautionary tale, it is not the best analog to consider in the case of Adcetris.
Targeting cancers with a high unmet need is a key driver in being able to demand high prices. Better analogs to consider are Istodax® (romidepsin, Celgene), approved for second-line Cutaneous T-cell Lymphoma (CTCL) and second-line Peripheral T-cell Lymphoma (PTCL), and Folotyn® (pralatrexate, Allos), approved for second-line PTCL. ALCL happens to be a subtype of PTCL. Of the PTCL patients included in the respective pivotal Istodax and Folotyn programs, approximately 15% were ALCL patients in both. There is overlap in the populations that all three drugs serve; all with substantial unmet needs. Likewise, third-line HD patients and those that have failed Autologous Stem Cell Transplantation (ASCT) both are populations with high unmet needs. Unfortunately high unmet needs sometimes imply small populations, another key driver in pushing up price to gain sales.
The developers for all three companies clearly base their strategies on these premises. CTCL and PTCL each represent approximately 5% of the approximately 60,000 Non-Hodgkin’s Lymphoma (NHL) patients diagnosed each year. Whittling down past incidence to second and third-line populations severely shrinks the available patients in each setting. Then take into account that ALCL represents approximately one-third of PTCL patients, this portion of the Adcetris® potential is fairly small. The largest upside for Adcetris® is the HD indication. The unmet need in HD is a better agent for those who have lost response after ASCT or are not eligible for ASCT. Seattle Genetics and Takeda argue that Adcetris® is the drug to serve this unmet need. This need for effective therapies in HD and ALCL will be the immediate driver of uptake of Adcetris.
Arguments can be made that Istodax and particularly Folotyn have perhaps underperformed due to cost. Perhaps it was efficacy or adverse events? Perhaps it is the overall value of the drug taking into account monetary cost and the risk for adverse events for the level of efficacy. Seattle Genetics would argue that the response rate for Adcetris will drive utilization. A better toxicity profile than the best alternative in combination chemotherapy for HD and ALCL will likely play a big role as well.
With cost of therapy being an overriding issue, let’s estimate how much these agents actually cost using response rates and duration of response from the key clinical trials. The response rates of Istodax® and Folotyn®are lower than those of Adcetris®; few patients actually experience the high cost of therapy. In responding patients, all three agents have quite a long duration of therapy that equates to a high cost, but also high benefit. Comparing the cost of therapy for responders, the price of Adcetris is in line with Istodax and Folotyn. True, Adcetris® comes at a high cost, but it serves several unmet needs.