Pcn226 the Cost-Effectiveness and Relapse-Reduction Benefit of Introducing Adjuvant Nivolumab for Patients With Completely With Resected Melanoma With Lymph Node Involvement or Metastatic Disease in the Uk

Abstract

Objectives: To evaluate the cost-effectiveness of treating relapsed/refractory multiple myeloma (RRMM) with carfilzomib, lenalidomide plus dexamethasone (KRd) compared to lenalidomide plus dexamethasone (Rd) and with carfilzomib plus dexamethasone (Kd) versus bortezomib plus dexamethasone (Vd) from a Colombian third-party payer perspective. Methods: An economic model was developed to estimate the treatment acquisition costs relative to treatment outcomes for KRd versus Rd and Kd versus Vd in the treatment of RRMM. Efficacy data were based on the ASPIRE and ENDEAVOR head-to-head pivotal trials comparing the therapies of interest. Only treatment acquisition costs were considered and were obtained from local price databases and expressed in local currency. Results were expressed as incremental cost per incremental month of duration of response (DOR), progression free survival (PFS) and overall survival respectively. A threshold of 3 times GDP per capita (63M COP) was considered to assess the comparative cost-effectiveness of each intervention. A scenario considering no drug wastage was also explored. Results: Both combinations with carfilzomib (KRd and Kd) were cost-effective (,3 times GDP per capita) compared to Rd and Vd respectively. For Kd versus Vd, ICERs ranged between 37.19M COP and 53.33M COP, with median DOR being the scenario with the lowest ICER, followed by median PFS. For KRd versus Rd, median PFS provided the most cost-effective scenario followed by median OS, within a 52.95M to 62.26M COP ICER range. When no drug wastage was considered, ICERs were lower by 19% across all outcomes compared to the base case analysis. Conclusions: Carfilzomib is likely to be a cost-effective treatment option for RRMM patients from a third-party payer perspective in Colombia, attributable to its demonstrated superior clinical profile. Further analysis including other direct medical costs, discounts and survival estimate variations is warranted to assess additional foreseeable gains/savings.

Adjuvant treatment of high-risk melanoma – cost-effectiveness analysis of treatment options for BRAF 600 mutated tumors

“…For nivolumab, due to immature data, no survival curves for overall survival were not available until late 2020. Different approaches to construct surrogates for the missing survival curve were presented [71,72], which usually project results from study CA184-029 (ipilimumab vs. placebo) [21] to the relationship ipilimumab vs. nivolumab, which was investigated in study Checkmate-238 [33]. Batteson et.al [71].…”

“…presented an alternative surrogate based on systematic research of available literature. On this basis, a series of country-specific costeffectiveness calculations for the relationship nivolumab vs. observation were presented as congress papers (for Spain [73], Greece [74], the National Health Service (UK) [72], Switzerland [75]). Also as congress papers, a comparison of the combination therapy dabrafenib/trametinib vs. observation for Canada [76] with observation and a comparison of dabrafenib/trametinib with pembrolizumab for Brazil [77] were presented.…”

“…Due to the lack of availability of patient level data, the potential bias by the imbalance of patient characteristics, as shown in Table 4, could not be assessed by sensitivity analyses. Ntais et.al [72]. showed an ICER value of £ 18,018/QALY for the relationship nivolumab vs.…”

“…The cycle length of 6 months assumed in the base case may be too long to estimate short-term effects after the start of treatment with sufficient accuracy. Other authors used shorter model cycles [41,72]. However, a sensitivity analysis revealed a relatively small influence of cycle length on the model result.…”