Cost-effectiveness of immune checkpoint inhibition and targeted treatment in combination as adjuvant treatment of patient with BRAF-mutant advanced melanoma

BMC Health Services Research

Research Article

Ya Min Li¹  Si Ni Li²  Xiaomin Wan³  Liu Bao Peng³  Jian He Li⁴ 

[1] Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, 410011, Changsha, China;Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, 410011, Changsha, China;The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hongkong, China;School of Health and Related Research, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK;Department of Pharmacy, The Second Xiangya Hospital, Central South University, 410011, Changsha, China;Department of Pharmacy, The Second Xiangya Hospital, Central South University, 410011, Changsha, China;Present address: The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, 410011, Changsha, Hunan, China;

关键词: Advanced melanoma;    Cost-effectiveness;    Immunotherapy;    Microsimulation;   

DOI  :  10.1186/s12913-023-09058-7

 received in 2022-06-20, accepted in 2023-01-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundImmune checkpoint inhibitors (ICIs) and targeted treatments have improved the health outcomes of patients with advanced melanoma. However, due to the high cost of novel therapies, it is crucial to evaluate their value by considering both effectiveness and cost. To compare the cost-effectiveness of these novel agents (atezolizumab-vemurafenib-cobimetinib, vemurafenib-plus-cobimetinib, dabrafenib-plus-trametinib, and encorafenib-plus-binimetinib) for first-line treatment of metastatic melanoma with the BRAFV600 mutation.MethodsA patient-level model was developed to project the health outcomes of 4 strategies for patients with advanced melanoma. We estimated transition probabilities from the IMspire150 (ClinicalTrials.gov, NCT02908672), COMBI-AD (NCT01682083), and COLUMBUS (NCT01909453) trials using a parametric survival model. All health outcomes, including direct cost, quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER), were estimated from the US payer perspective. Lifetime cost, QALYs, life-years (LYs), and ICERs were calculated. Univariable and probabilistic sensitivity analyses were performed to test model robustness, along with multiple scenario analyses.ResultsOf the 4 competing strategies, atezolizumab-vemurafenib-cobimetinib produced the best health outcomes, and the vemurafenib-cobimetinib strategy was the least expensive option. Atezolizumab-vemurafenib-cobimetinib, dabrafenib-plus-trametinib, and vemurafenib-cobimetinib formed the cost-effective frontier, indicating that the ordered ICERs were $325,113/QALYs for dabrafenib-plus-trametinib vs. vemurafenib-cobimetinib strategies and $2,247,500/QALYs for atezolizumab-vemurafenib-cobimetinib vs. dabrafenib-plus-trametinib strategies. Encorafenib-plus-binimetinib was dominated by the other 3 competing strategies. The drug price and first-line utility significantly influenced the model utcomes.ConclusionsFor BRAF-mutant advanced melanoma, the vemurafenib-cobimetinib strategy could be considered the most cost-effective treatment at the willingness-to-pay threshold of $150,000.

【 授权许可】

CC BY   
© The Author(s) 2023

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