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Published on: September 8, 2021
Cost-Effectiveness of Immune Checkpoint Inhibition in BRAF Wild-Type Advanced Melanoma
Christine G Kohn1, Simon B Zeichner1, Qiushi Chen1
1Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G. Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers, Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.
For advanced melanoma, pembrolizumab (PEM) every 3 weeks followed by ipilimumab (IPI) or nivolumab (NIVO) followed by IPI are the most cost-effective immune-based strategies. These treatments offer better value for patients with BRAF wild-type metastatic melanoma.
Area of Science:
- Oncology
- Pharmacoeconomics
- Immunotherapy
Background:
- Stage IV metastatic melanoma has a poor 5-year survival rate (17%).
- Immune checkpoint inhibitors like pembrolizumab (PEM), nivolumab (NIVO), and ipilimumab (IPI) have improved outcomes.
- Optimal sequencing of these agents for BRAF wild-type melanoma is unclear.
Purpose of the Study:
- To compare the cost-effectiveness of different sequencing strategies for novel agents in advanced melanoma.
- To inform policy regarding the value of immune checkpoint inhibitors.
Main Methods:
- A Markov model was developed from a US-payer perspective with a lifetime horizon.
- Estimated costs and quality-adjusted life years (QALYs) for various treatment sequences.
- Utilized data from phase III trials for transition probabilities between health states (initial treatment, progression, death).
Main Results:
- Pembrolizumab (PEM) every 3 weeks followed by second-line ipilimumab (IPI) was more effective and less costly than other strategies.
- Nivolumab (NIVO) followed by IPI yielded an ICER of $90,871/QALY versus dacarbazine.
- First-line NIVO + IPI followed by chemotherapy had an ICER of $198,867/QALY.
Conclusions:
- First-line PEM every 3 weeks followed by second-line IPI is a highly cost-effective strategy.
- First-line NIVO followed by second-line IPI is also a cost-effective immune-based treatment option.
- These strategies represent optimal sequencing for treatment-naive BRAF wild-type advanced melanoma.
