Can We Accurately Predict Cost Effectiveness Without Access to Overall Survival Data? The Case Study of Nivolumab in Combination with Ipilimumab for the Treatment of Patients with Advanced Melanoma in England

Lee, D; Amadi, A.; Sabater, J; Ellis, J; Johnson, Helen M.; Kotapati, Srividya; McNamara, Simon; Walker, Andrew; Cooper, Miranda; Patterson, K.; Roskell, Neil; Meng, Yang

doi:10.1007/s41669-018-0080-5

Cited by 17 publications

(11 citation statements)

References 14 publications

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“…The models also incorporated random effects to account for and to quantify cross-study variability. Compared to simple pooling of data from multiple studies, which has been used in several oncology economic models (54,55), this approach more accurately revealed the uncertainty around the survival estimates.…”

Section: Discussionmentioning

confidence: 99%

Association of Pathologic Complete Response with Long-Term Survival Outcomes in Triple-Negative Breast Cancer: A Meta-Analysis

et al. 2020

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is an employee of Analysis Group, Inc., which received consultancy fees from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA to conduct this study. Jipan Xie is an employee of Analysis Group, Inc., which received consultancy fees from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA to conduct this study. Muhan Yuan is an employee of Analysis Group, Inc., which received consultancy fees from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA to conduct this study. John Cook received grants from Merck & Co., Inc. during the conduct of this study.

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Section: Discussionmentioning

confidence: 99%

Association of Pathologic Complete Response with Long-Term Survival Outcomes in Triple-Negative Breast Cancer: A Meta-Analysis

et al. 2020

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“…Several papers have recently been published comparing cost-effectiveness results across different model structures in the field of oncology [7–13]. These indicate that different models may provide different results, thus highlighting the importance of justifying the selected approach and assessing the impact of structural uncertainty (in other words, uncertainty in the functional form of the model constructed).…”

Section: Introductionmentioning

confidence: 99%

A Review of Recent Decision-Analytic Models Used to Evaluate the Economic Value of Cancer Treatments

Bullement¹,

Cranmer

Shields

2019

Appl Health Econ Health Policy

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Cost-effectiveness analysis provides information on the potential value of new cancer treatments, which is particularly pertinent for decision makers as demand for treatment grows while healthcare budgets remain fixed. A range of decision-analytic modelling approaches can be used to estimate cost effectiveness. This study summarises the key modelling approaches considered in oncology, alongside their advantages and limitations. A review was conducted to identify single technology appraisals (STAs) submitted to the National Institute for Health and Care Excellence (NICE) and published papers reporting full economic evaluations of cancer treatments published within the last 5 years. The review was supplemented with the existing methods literature discussing cancer modelling. In total, 100 NICE STAs and 124 published studies were included. Partitioned-survival analysis (n = 54) and discrete-time state transition structures (n = 41) were the main structures submitted to NICE. Conversely, the published studies reported greater use of discrete-time state transition models (n = 102). Limited justification of model structure was provided by authors, despite an awareness in the existing literature that the model structure should be considered thoroughly and can greatly influence cost-effectiveness results. Justification for the choice of model structure was limited and studies would be improved with a thorough rationale for this choice. The strengths and weaknesses of each approach should be considered by future researchers. Alternative methods (such as multi-state modelling) are likely to be utilised more frequently in the future, and so justification of these more advanced methods is paramount to their acceptability to inform healthcare decision making.Electronic supplementary materialThe online version of this article (10.1007/s40258-019-00513-3) contains supplementary material, which is available to authorized users.

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“…Multiple studies have previously carried out health economic analyses in advanced melanoma [26–30]. The results presented in these economic evaluations are not comparable to the results from the current analysis on account of the following differences between the methodologies adopted by the earlier evaluations and our study:All the other studies involve cost-effectiveness analyses (CEA) which takes into account both costs and outcomes and compute the ratio of incremental costs to incremental effectiveness (life years or quality-adjusted life years).…”

Section: Discussionmentioning

confidence: 99%

Healthcare cost comparison analysis of nivolumab in combination with ipilimumab versus nivolumab monotherapy and ipilimumab monotherapy in advanced melanoma

Potluri¹,

Ranjan²,

Bhandari³

et al. 2019

Exp Hematol Oncol

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Background Monoclonal antibodies targeting the cytotoxic T-lymphocyte-associated antigen 4 (CTLA4) (e.g., ipilimumab [IPI]) and the programmed cell death-1 (PD1) receptor (e.g., nivolumab [NIVO]) represent significant breakthroughs in the treatment of advanced melanoma. A combination of the 2 agents has demonstrated efficacy and survival benefits over NIVO or IPI monotherapy in treating advanced melanoma. We compared melanoma-specific costs following treatment with NIVO + IPI, NIVO monotherapy, or IPI monotherapy from the UK and German perspectives to ascertain whether these clinical benefits resulted in a cost advantage. Methods Patient-level resource utilization data for the three treatment cohorts were obtained from the CheckMate 067 trial (NCT01844505). All melanoma-specific resources, including drugs (index, concomitant and subsequent melanoma medications), office visits, emergency room visits, hospitalizations, lab tests, procedures and surgeries, utilized over a 48-month evaluation period after start of index treatment were included. Unit costs specific to each geography were applied from external sources. Mean costs per surviving patients were calculated for each successive 30-day period from treatment start and aggregated over the evaluation period. Results The total per-patient costs incurred by advanced melanoma patients over the 48-month period following treatment initiation with NIVO + IPI were 9% lower than NIVO monotherapy (£226k vs £248k) and 3% lower compared to IPI monotherapy (£226k vs. £233k) in the UK. In Germany, the total costs incurred by NIVO + IPI cohort were 5% lower than NIVO monotherapy (€258k vs €271k) and 4% lower compared to IPI monotherapy (€258k vs. €268k). Drug costs accounted for > 85% of total costs. Non-drug costs were slightly higher for NIVO + IPI and IPI monotherapy because of higher hospitalization rates. Costs incurred on subsequent drugs post progression were about 45% and 65% lower in NIVO + IPI cohort compared with NIVO and IPI monotherapy cohorts respectively. Conclusions The total costs incurred by a patient over a 48-month period following treatment initiation with NIVO + IPI are lower when compared with patients initiating monotherapies; further, the cost advantage is seen to be increasing over time. The clinical benefits offered by the regimen are thus supplemented by a cost advantage, as patients receiving either monotherapy treatment experience faster progression and, consequently, higher subsequent treatment costs. (Note: The cost results reported here are specific to the UK, and Germany, and may not be generalizable to other geographies). Electronic supplementary material The online version of this article (10.1186/s40164-019-0138-9) contains supplementary material, which is available to authorized users.

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Can We Accurately Predict Cost Effectiveness Without Access to Overall Survival Data? The Case Study of Nivolumab in Combination with Ipilimumab for the Treatment of Patients with Advanced Melanoma in England

Cited by 17 publications

References 14 publications

Association of Pathologic Complete Response with Long-Term Survival Outcomes in Triple-Negative Breast Cancer: A Meta-Analysis

Association of Pathologic Complete Response with Long-Term Survival Outcomes in Triple-Negative Breast Cancer: A Meta-Analysis

A Review of Recent Decision-Analytic Models Used to Evaluate the Economic Value of Cancer Treatments

Healthcare cost comparison analysis of nivolumab in combination with ipilimumab versus nivolumab monotherapy and ipilimumab monotherapy in advanced melanoma

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