Sequential treatment approaches in  the management of BRAF wild-type advanced melanoma: a cost–effectiveness analysis. (17th October 2018)

• Record Type: Journal Article
• Authors: Tarhini, Ahmad; Benedict, Agnes; McDermott, David; Rao, Sumati; Ambavane, Apoorva; Gupte-Singh, Komal; Sabater, Javier; Ritchings, Corey; Aponte-Ribero, Valerie; Regan, Meredith M; Atkins, Michael
• Is Part Of: Immunotherapy. Volume 10:Number 14(2018)
• Page Start: 1241
• Page End: 1252
• Publication Date: 2018-10-17
• Subjects: economic models -- ipilimumab -- nivolumab; Immunotherapy -- Periodicals; 615.37
• DOI: 10.2217/imt-2018-0085
• Languages: English
• ISSNs: 1750-743X

Abstract

Aim: To evaluate the cost–effectiveness of treatment sequences with checkpoint inhibitors in patients with BRAF wild-type melanoma.Materials & methods: Using a discrete event simulation model, cost and health outcomes were estimated. Pooled data from CheckMate 067/069 trials were used to calculate survival outcomes including treatment-free interval extrapolated over a patient's lifetime. Costs accounted for treatment, administration, toxicity, and disease management.Results: First-line anti-PD-1 + anti-CTLA-4 initiating sequences had the highest estimated mean survival gain (7.6–7.7 years), driven by a longer estimated mean treatment-free interval (5.3 years). Incremental costs per incremental quality-adjusted life year gained for anti-PD-1 + anti-CTLA-4 followed by chemotherapy were US$30, 955 versus anti-PD-1 initiating sequences, within the willingness-to-pay threshold.Conclusion: Anti-PD-1 + anti-CTLA-4 initiating sequences for BRAF wild-type melanoma are cost-effective versus anti-PD-1.