Background Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the largest and longest-running telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. Methods A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state). The model lifetime in the base case was 10 years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. Results The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the 10 years lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4245. The incremental cost-effectiveness ratio (ICER) for the SCAD programme over standard care was estimated at €4579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. Conclusions Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

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Background Based on the results of the phase III randomized 20120215 trial, the European Medicines Agency granted the approval of blinatumomab for the treatment of pediatric patients with high-risk first-relapsed Philadelphia chromosomenegative B-cell precursor acute lymphoblastic leukemia (ALL). In France, blinatumomab received reimbursement for this indication in May 2022. This analysis assessed the cost effectiveness of blinatumomab compared with high-risk consolidation chemotherapy (HC3) in this indication from a French healthcare and societal perspective. Methods A partitioned survival model with three health states (event-free, post-event and death) was developed to estimate life-years (LYs), quality-adjusted life-years (QALYs) and costs over a lifetime horizon. Patients who were alive after 5 years were considered to be cured. An excess mortality rate was applied to capture the late effects of cancer therapy. Utility values were based on the TOWER trial using French tariffs, and cost input data were identified from French national public health sources. The model was validated by clinical experts. Results Treatment with blinatumomab over HC3 was estimated to provide gains of 8.39 LYs and 7.16 QALYs. Total healthcare costs for blinatumomab and HC3 were estimated to be €154,326 and €102,028, respectively, resulting in an increment of €52,298. The incremental cost-effectiveness ratio was estimated to be €7308 per QALY gained from a healthcare perspective. Results were robust to sensitivity analyses, including analysis from the societal perspective. Conclusions Blinatumomab administered as part of consolidation therapy in pediatric patients with high-risk first-relapsed ALL is cost effective compared with HC3 from the French healthcare and societal perspective.

The objective of this study was to evaluate the cost-effectiveness of nivolumab in combination with ipilimumab (Nivo+Ipi) compared to current therapeutic alternatives in first-line treatment of patients with advanced melanoma regardless of biomarker status in Belgium from a healthcare payer perspective using 48-month survival data from the CheckMate 067 Phase III trial. Methods: A threestate partitioned survival model was developed from projections of overall survival and progression free survival based on a network meta-analysis which considers time-varying hazard ratios to estimate accrued quality-adjusted survival and costs over a 30-year time horizon. The analysis considered nivolumab monotherapy as the key comparator but also included ipilimumab, pembrolizumab, dabrafenib, dabrafenib + trametinib, vemurafenib + cobimetinib, and dacarbazine. Drug acquisition, administration, follow-up, subsequent therapy and adverse event costs were obtained via published sources and expert input. Adverse event frequencies were collected from the Checkmate 067 trial and published literature. Utility weights were estimated from the Checkmate 067 trial, based on Belgian tariffs. A 3% discount rate was applied to costs and 1.5% rate to utilities. Results were presented as incremental cost-utility ratios (ICURs). BRAF status specific patterns of subsequent treatment were assigned. Results: Nivo+Ipi was projected to have the greatest accrued survival among the competing treatments with 8.8 LYs and 6.2 QALYs. The comparisons vs. nivolumab resulted in an ICUR of approximately V22,000 per QALY. Pairwise ICURs for Nivo+Ipi vs. other treatments ranged from V25,000 per QALY (vs. ipilimumab) to V38,000 per QALY (vs. dacarbazine). Conclusions: The analysis highlighted that Nivo+Ipi is associated with the highest gain in quality-adjusted survival accompanied by higher costs compared to the current therapeutic alternatives. ICUR results indicated that Nivo+Ipi is a cost-effective option in the first-line treatment of advanced melanoma in Belgium.