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Effectiveness and cost-effectiveness of combination therapy versus monotherapy in malignant melanoma

Dilay Özdemir1, Melanie Büssgen2

  • 1University of Hamburg, Hamburg, Germany.

Journal of Pharmaceutical Policy and Practice
|September 25, 2023
PubMed
Abstract

Insights

Combination therapy improves survival for malignant melanoma (MM) patients. Immune checkpoint inhibitor (ICI) combinations are cost-effective, but BRAF/MEK inhibitor combinations are not.

Area of Science:

  • Oncology
  • Health Economics
  • Pharmacoeconomics

Background:

  • Advanced malignant melanoma (MM) historically had a poor prognosis before 2010.
  • Immune checkpoint inhibitors (ICIs) revolutionized MM treatment starting in 2011.
  • Combination therapies emerged as a promising strategy for advanced MM, with the first approved in 2016.

Purpose of the Study:

  • To evaluate the cost-effectiveness of combination therapy versus monotherapy for stage III or IV MM.
  • To compare the effectiveness (survival, response rates) of combination therapies against monotherapies.

Main Methods:

  • Systematic literature search across major databases (Web of Science, PubMed, etc.).
  • Inclusion of randomized controlled trials (RCTs) and cost-utility analyses from the past decade.
  • Focus on cost per Quality-Adjusted Life Year (QALY) and clinical effectiveness metrics.

Main Results:

  • Eleven RCTs and five cost-utility analyses met inclusion criteria.
  • Nine clinical trials showed combination therapy superior to monotherapy.
  • BRAF/MEK inhibitor combination therapy was not cost-effective; ICI combinations were cost-effective.

Conclusions:

  • Combination therapy offers superior effectiveness compared to monotherapy for advanced MM.
  • Combined immune checkpoint inhibitors (ICIs) demonstrate cost-effectiveness.
  • Combination therapy with BRAF and MEK inhibitors is not a cost-effective strategy.
Keywords:
BRAF inhibitorCombination therapyCost-effectivenessEffectivenessImmune checkpoint inhibitorsMEK inhibitorMalignant melanomaMelanomaOncologyTargeted therapy

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