PCN80 Modelling the Cost-Effectiveness of Ipilimumab for Previously-Treated, Metastatic Melanoma

Abstract

OBJECTIVES:To estimate the cost-effectiveness of maintenance therapy with oral erlotinib (150mg/day) and BSC compared with BSC, in patients with advanced nonsmall-cell lung cancer (NSCLC) EGFR WT and stable disease after completing four cycles of first-line platinum-based chemotherapy. METHODS: A Markov model including three health states (progression free survival, progression and death) was developed to evaluate the cost per life year gained (LYG) of maintenance treatment with erlotinib vs BSC from the Spanish National Healthcare System perspective. Clinical data inputs were based on the SATURN trial results. Resource utilization related to each health state was estimated by a Spanish Expert Panel. Drug and unitary costs were obtained from a Spanish database (€, 2012). The annual discount rate applied was 3.0% for cost and outcomes. The simulation was carried out over a 5 year time horizon and one-way deterministic and probabilistic sensitivity analyses were conducted to assess the uncertainty around key input values. RESULTS: In the prespecified subset of patients with EGFR WT and stable disease, the annual cost per patient of erlotinib and placebo, including supportive care and adverse events costs, was 23,912€ and 13,969€, respectively. Erlotinib also achieved a mean gain of 1.40 life-years compared with the 1.12 LYG with placebo. The incremental cost-effectiveness ratio of erlotinib relative to placebo was calculated to be 35,265 € per LYG. Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS: In patients with advanced NSCLC EGFR WT and stable disease after 4 cycles of chemotherapy, maintenance treatment with erlotinib is a therapeutic option that increases survival of patients and may be cost-effective vs BSC in Spain.

Cost–effectiveness of therapies for melanoma

“…Of the resulting 22 articles, 3 were excluded due to lack of relevance (1 was a review of original articles already included [31], 2 were comparisons of surgical options rather than pharmacologic therapies [32,33]), 1 was an abstract corresponding to a full-text article already included [34] and 3 were excluded for lack of sufficiently reported detail [30,35,36]. The resulting 15 articles were included in the review: seven described therapies for resectable melanoma [27,[37][38][39][40][41][42], while the remaining eight described therapies for unresectable or metastatic melanoma [19,26,28,29,[43][44][45].…”

“…A common feature of Markov models is that the probability of progressing to a different health state is independent of the time spent in a current health state; however, in both resectable and unresectable melanoma models, time-dependent transition probabilities were sometimes included to account for time-varying risk of transition to subsequent health states [27,41,44]. Across studies, time spent on treatment was either differentiated from off-treatment disease-free or progression-free survival time via a separate health state or combined into a single health state and accounted for via time-dependent health state costs.…”

“…Within the MDX 010-20 trial, the European Organization for Research and Treatment of Cancer Quality of Life Core questionnaire (EORTC-QLQ-C30) was administered to participants, and results were transformed into utility values using the EORTC-8D [62]. Identified analyses include published models describing populations from Portugal [45], the UK [44] as well as the publicly available model submitted by the manufacturer for consideration of reimbursement by NICE in the UK [26].…”

Cost Effectiveness of Pembrolizumab for Advanced Melanoma Treatment in Portugal

“…The cost-effectiveness results of ipilimumab use in previously treated patients were also reported for the United Kingdom. Lee et al [29] employed a model with a semi-Markov structure, in which the transition probabilities across states varied during three distinct time periods. Over the lifetime, ipilimumab, compared with the best supportive care, was associated with an added benefit of 1.7 LYs and 1.24 QALYs, corresponding to an ICER of £65,303 per QALY gained.…”