Estimated Cost-effectiveness of Atezolizumab Plus Cobimetinib and Vemurafenib for Treatment ofBRAF V600Variation Metastatic Melanoma

Abstract

IMPORTANCEIn the IMspire150 trial, triplet treatment with atezolizumab and vemurafenib plus cobimetinib significantly improved progression-free survival (PFS) compared with vemurafenib plus cobimetinib alone for treatment of BRAF V600 variation metastatic melanoma. However, considering high cost of this combination, it is unclear if the incremental cost is worth the additional survival benefit. OBJECTIVE To evaluate the cost-effectiveness of atezolizumab and vemurafenib plus cobimetinib vs vemurafenib plus cobimetinib alone in patients with newly diagnosed unresectable BRAF V600 variation metastatic melanoma from the US health care perspective. DESIGN, SETTING, AND PARTICIPANTSThis economic evaluation study used a 3-state partitioned survival model to assess the cost-effectiveness of the combination of atezolizumab with vemurafenib plus cobimetinib vs vemurafenib plus cobimetinib alone. The observed Kaplan-Meier curves for overall survival and PFS were digitized from the IMspire150 trial (January 2017-April 2018) and the long-term survivals (over a lifetime horizon) beyond the end of the trial were extrapolated using 7 different survival models. The cost and health preference data were collected from a literature review. This study was performed from March 2021 through June 2021. MAIN OUTCOMES AND MEASURESThe outcomes of interest were expected life-years (LYs) gained and quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratio (ICER), expressed as cost per LYs and per QALYs saved.

A real‐world study of adjuvant anti‐PD ‐1 immunotherapy on stage III melanoma with BRAF, NRAS, and KIT mutations

“…The combination of MEK inhibitor and anti‐PD‐1 immunotherapy was considered as a promising option. However, the phase III clinical trial of atezolizumab plus cobimetinib in advanced melanoma failed to demonstrate superior survival over anti‐PD‐1 monotherapy 43 . Other combination strategies, such as CDK4/6 inhibitors, autophagy inhibitors, or HDAC inhibitors, are also under investigation to overcome the subsequent monotherapy resistance and to prolong the survival 44–46 …”

“…However, the phase III clinical trial of atezolizumab plus cobimetinib in advanced melanoma failed to demonstrate superior survival over anti-PD-1 monotherapy. 43 Other combination strategies, such as CDK4/6 inhibitors, autophagy inhibitors, or HDAC inhibitors, are also under investigation to overcome the subsequent monotherapy resistance and to prolong the survival. [44][45][46] Another interesting result in our study is that patients with KIT mutations also showed no survival benefit from anti-PD-1 adjuvant therapy than IFN/OBS.…”

Cost-effectiveness of utidelone and capecitabine versus monotherapy in anthracycline- and taxane-refractory metastatic breast cancer

“…The cost-effectiveness was evaluated using a partitioned survival model derived from the NCT02253459 trial data ( Partitioned survival model, 2016 ). This model is routinely employed to assess the financial and efficacy outcomes in metastatic oncology research ( Insinga et al, 2018 ; Chouaid et al, 2019 ; Loong et al, 2020 ; Cai C. et al, 2021 ). It delineates three distinct health states ( Figure 1 ): the progression-free state (from patient entry until the onset of disease progression), the progressive disease (PD) state (spanning the time the patient remains alive post the initiation of disease progression), and the terminal state.…”

Cost-effectiveness analysis of serplulimab in combination with cisplatin plus 5-fluorouracil chemotherapy compared to cisplatin plus 5-fluorouracil chemotherapy as first-line treatment for advanced or metastatic esophageal squamous cell carcinoma in China

“…This model is frequently employed to analyze advanced tumor diagnosis and treatment clinical efficacy and health care costs. [20][21][22][23] Three mutually exclusive health states were constructed in the current study: diseasefree progression, disease progression, and the terminal stage, as depicted in Figure 1. The model operated on a 2-week (14 days) cycle over an evaluation horizon of 240 weeks, consistent with the ASTRUM-007 trial's clinical treatment timeline.…”