A cost‐utility analysis of avelumab for metastatic Merkel cell carcinoma in Taiwan

Abstract

Background: Metastatic Merkel cell carcinoma (mMCC) has traditionally been managed with palliative chemotherapy regimens or best supportive care (BSC). Avelumab, a novel anti-programmed death-ligand 1 (PD-L1) human monoclonal antibody for mMCC treatment, is being studied in the pivotal JAVELIN Merkel 200 trial.Aim: Incorporating trial results, this analysis aimed to evaluate the cost-utility of avelumab in Taiwan.Methods and results: A de novo partitioned-survival model with three key health states related to survival (progression-free disease, progressed disease, and death) was applied in this study. The data of clinical efficacy, safety, and patient utilities were obtained from the JAVELIN Merkel 200 trial, literature review, and Taiwanese clinical expert opinion.Cost-utility analysis was performed, and results were presented as cost per qualityadjusted life year (QALY) gained. For treatment-naïve patients, the incremental costeffectiveness ratios (ICERs) for avelumab vs BSC and avelumab vs chemotherapy were US$44885.06 and US$42993.06 per QALY gained, respectively. As to treatmentexperienced mMCC patients, avelumab was associated with ICERs of US$27243.06 (vs BSC)/US$26557.43 (vs chemotherapy) per QALY gained. All ICERs remained consistently within the willingness-to-pay (WTP) threshold of US$53,333.33 per QALY gained. Conclusion:This study demonstrated avelumab to be a cost-effective treatment option for both treatment-experienced and treatment-naïve mMCC patients with very poor prognosis in Taiwan.

Cost-Effectiveness of Treatment Optimisation with Biomarkers for Immunotherapy in Solid Tumours: A Systematic Review

“…Three cost-effectiveness analyses were retrieved on ICIs used for the treatment of melanoma and Merkel cell carcinoma (MCC) [ 62 , 63 , 64 ]. For metastatic MCC, avelumab treatment with previous PD-L1 assessment was cost-effective compared to best supportive care (ICER USD 44,885.06/QALY, WTP USD 53,333.33/QALY) and chemotherapy (ICER USD 42,993.06/QALY) [ 64 ] ( Figure 5 ).…”

“…Three cost-effectiveness analyses were retrieved on ICIs used for the treatment of melanoma and Merkel cell carcinoma (MCC) [ 62 , 63 , 64 ]. For metastatic MCC, avelumab treatment with previous PD-L1 assessment was cost-effective compared to best supportive care (ICER USD 44,885.06/QALY, WTP USD 53,333.33/QALY) and chemotherapy (ICER USD 42,993.06/QALY) [ 64 ] ( Figure 5 ). Regarding patients with advanced melanoma, nivolumab was the most cost-effective treatment option in BRAF wild-type and BRAF mutant patients, as demonstrated by the Markov model developed to estimate the lifetime costs and benefits of nivolumab versus ipilimumab and dacarbazine (for BRAF wild-type) and versus ipilimumab, dabrafenib, and vemurafenib (for BRAF mutant patients) [ 62 ].…”

The Evaluation of Effects, Mechanisms, and Clinical Data of Avelumab

“…Avelumab is available in 200mg vials, which cost 1039.43 per vial on average, which indicates US$5.20 per mg. With the assumption that an average MCC patient weight 60kg requires 600 mg of Avelumab, including vial wastage, which costs US$3118.30 [15]. Although there is a more expensive cancer drug, the price is still overwhelmingly high for many families.…”