Cost-effectiveness analysis of pembrolizumab compared to standard of care as first line treatment for patients with advanced melanoma in Hong Kong

Abstract

Background: Pembrolizumab has been shown to improve overall survival (OS) and progression free survival (PFS) compared to ipilimumab in patients with ipilimumab-naïve advanced melanoma; however, there are no published data on the cost-effectiveness for pembrolizumab compared to standard-of-care treatments currently used in Hong Kong for advanced melanoma. Methods: A partitioned-survival model based on data from a recent randomized phase 3 study (KEYNOTE-006) and meta-analysis was used to derive time in PFS, OS, and post-progression survival for pembrolizumab and chemotherapy, such as dacarbazine (DTIC), temozolomide (TMZ), and the paclitaxel-carboplatin combination (PC). A combination of clinical trial data, published data, results of meta-analysis, and melanoma registry data was used to extrapolate PFS and OS curves. The base-case time horizon for the model was 30 years with costs and health outcomes discounted at a rate of 5% per year. Individual patient level data on utilities and frequencies of adverse events were obtained from the final analysis of KEYNOTE-006 (cut-off date: 3-Dec-15) for pembrolizumab. Cost data included drug acquisition, treatment administration, adverse event management, and clinical management of advanced melanoma. The distribution of patient weight from the Hong Kong population was applied to calculate the drug costs. Analyses were performed from a payer's perspective. The incremental cost effectiveness ratio (ICER) expressed as cost in US Dollars (USD) per quality-adjusted life years (QALYs) was the main outcome. Results: In base-case scenario, the ICER for pembrolizumab as a first-line treatment for advanced melanoma was USD49,232 compared to DTIC, with the ICER values lower than cost-effectiveness threshold in Hong Kong. Results comparing pembrolizumab to TMZ and to PC were similar to that when compared to DTIC. Probability sensitivity analyses showed that 99% of the simulated ICERs were below three times the Gross Domestic Product (GDP) per capita for Hong Kong (currently at $119,274//QALY threshold). In a scenario analysis comparing pembrolizumab with ipilimumab, the estimated ICER was USD8,904. Conclusions: Pembrolizumab is cost-effective relative to chemotherapy (DTIC, TMZ and PC), and highly-cost-effective compared to ipilimumab, for the first-line treatment of advanced melanoma in Hong Kong.

Cost-Effectiveness of Pembrolizumab Versus Carboplatin and Paclitaxel in Patients With Unresectable or Metastatic Melanoma After First-Line Treatment in China

“…The findings of our study are consistent with those of previous studies evaluating the cost-effectiveness of pembrolizumab in the advanced melanoma setting, which demonstrated that pembrolizumab is a cost-effective therapy to treat advanced melanoma across different settings. [27][28][29][30][31] This is also supported by the findings of 3 systematic reviews, which identified economic evaluations of treatments for advanced melanoma, and concluded that anti-PD-1s (such as pembrolizumab), administered as monotherapy, have been consistently found to be cost-effective relative to other therapies such as ipilimumab, combination of nivolumab and ipilimumab, or treatment with BRAF monotherapy or BRAF/MEK combination therapy among BRAF-positive patients. [32][33][34] Specifically within an Asian setting, the study conducted by Loong et al 27 evaluated the cost-effectiveness of pembrolizumab versus DTIC as a treatment for treatment-naïve patients with advanced melanoma and concluded that pembrolizumab is a cost-effective first-line treatment option for patients with advanced melanoma in Hong Kong.…”

“…[32][33][34] Specifically within an Asian setting, the study conducted by Loong et al 27 evaluated the cost-effectiveness of pembrolizumab versus DTIC as a treatment for treatment-naïve patients with advanced melanoma and concluded that pembrolizumab is a cost-effective first-line treatment option for patients with advanced melanoma in Hong Kong. 27…”

Cost-Effectiveness of Nivolumab Immunotherapy vs. Paclitaxel or Docetaxel Chemotherapy as Second-Line Therapy in Advanced Esophageal Squamous Cell Carcinoma in China

“…The cost-effectiveness of treatment with nivolumab and chemotherapy with paclitaxel or docetaxel was assessed using a partitioned survival model (24) based on the ATTRACTION-3 trial data. This model has often been used in testing medical costs and efficacy outcomes of metastatic oncology modeling (25)(26)(27)(28). The model has three mutually exclusive health stages (Figure 1): progression-free stage (patient entered until disease progression occurred), progressive disease (PD) stage (patient was alive after the disease progression began), and terminal stage.…”

Cost-effectiveness analysis of sintilimab plus chemotherapy versus chemotherapy alone for the first-line treatment of advanced oesophageal squamous cell carcinoma

“…A partitioned survival model (PSM) was developed to evaluate the long-term cost and health bene ts of sintilimab combined with chemotherapy vs. chemotherapy alone in the rstline treatment of ESCC. The model is widely used to assess the long-term medical costs and clinical bene ts of antitumour drugs [12,13]. The PSM included three mutually exclusive health states: PFS, progressive disease (PD), and death.…”