Clinical and economic outcomes associated with treatment sequences in patients with BRAF-mutant advanced melanoma. (19th December 2018)

• Record Type: Journal Article
• Authors: Tarhini, Ahmad; McDermott, David; Ambavane, Apoorva; Gupte-Singh, Komal; Aponte-Ribero, Valerie; Ritchings, Corey; Benedict, Agnes; Rao, Sumati; Regan, Meredith M; Atkins, Michael
• Is Part Of: Immunotherapy. Volume 11:Number 4(2019)
• Page Start: 283
• Page End: 295
• Publication Date: 2018-12-19
• Subjects: anti-CTLA-4 + anti-PD-1 -- checkpoint inhibition -- treatment sequences; Immunotherapy -- Periodicals; 615.37
• DOI: 10.2217/imt-2018-0168
• Languages: English
• ISSNs: 1750-743X

Abstract

Aim: The cost–effectiveness of treatment sequences in BRAF -mutant advanced melanoma.Materials & methods: A discrete event simulation model was developed to estimate total costs and health outcomes over a patient's lifetime (30 years). Efficacy was based on the CheckMate 067/069 trials and a matching-adjusted-indirect comparison between immuno-oncology and targeted therapies. Safety, cost (in US dollars; US third-party payer perspective) and health-related quality-of-life inputs were based on published literature.Results: Estimated survival gain was higher for sequences initiating with anti-PD-1 + anti-CTLA-4 than for anti-PD-1 monotherapy or BRAF+MEK inhibitors. The incremental cost–effectiveness ratio per QALY gained for first-line anti-PD-1 + anti-CTLA-4 was US$54, 273 versus first-line anti-PD-1 and $79, 124 versus first-line BRAF+MEK inhibitors.Conclusion: Initiating treatment with anti-PD-1 + anti-CTLA-4 was more cost–effective than initiation with anti-PD-1 monotherapy or BRAF+MEK inhibitors.