Cost-Effectiveness of Pembrolizumab for Unresectable Metastatic Melanoma After Progression with Ipilimumab in England

Marriott, Emily Ruth; Praet, Charles Van; Aguiar-Ibáñez, R.; Pellissier, James M.; Xu, Ruifeng; Wang, J

doi:10.1016/j.jval.2015.09.1150

Cited by 8 publications

(3 citation statements)

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“…A patient-level simulation model was developed to estimate the incidence of various disease milestones and the associated total costs and health outcomes over the patient's lifetime (30 years) for treatment-naive BRAF-mutant advanced melanoma. Similar time horizons were used in other models for advanced melanoma studies [27][28][29][30]. Such a simulation model allowed for the incorporation of detailed clinical trial data to evaluate clinical outcomes, based on baseline patient characteristics and their changes over time.…”

Section: Model Overviewmentioning

confidence: 99%

Clinical and Economic Outcomes Associated with Treatment Sequences In Patients With BRAF -Mutant Advanced Melanoma

et al. 2018

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Aim: The cost–effectiveness of treatment sequences in BRAF-mutant advanced melanoma. Materials & methods: A discrete event simulation model was developed to estimate total costs and health outcomes over a patient's lifetime (30 years). Efficacy was based on the CheckMate 067/069 trials and a matching-adjusted-indirect comparison between immuno-oncology and targeted therapies. Safety, cost (in US dollars; US third-party payer perspective) and health-related quality-of-life inputs were based on published literature. Results: Estimated survival gain was higher for sequences initiating with anti-PD-1 + anti-CTLA-4 than for anti-PD-1 monotherapy or BRAF+MEK inhibitors. The incremental cost–effectiveness ratio per QALY gained for first-line anti-PD-1 + anti-CTLA-4 was US$54,273 versus first-line anti-PD-1 and $79,124 versus first-line BRAF+MEK inhibitors. Conclusion: Initiating treatment with anti-PD-1 + anti-CTLA-4 was more cost–effective than initiation with anti-PD-1 monotherapy or BRAF+MEK inhibitors.

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Section: Model Overviewmentioning

confidence: 99%

Clinical and Economic Outcomes Associated with Treatment Sequences In Patients With BRAF -Mutant Advanced Melanoma

et al. 2018

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“…With the advent of pembrolizumab as a new adjuvant treatment option, it will be important for payers and decision-makers to understand whether this immunotherapy represents good value for resources relative to standard of care in this indication. While studies have examined the costeffectiveness of pembrolizumab as a treatment for advanced melanoma in the US 27 and European settings 28,29 , there have been no published economic evaluations of pembrolizumab or any other novel immunotherapy as adjuvant treatment for melanoma. Prior economic evaluations in this setting have been limited to interferon-based regimens [30][31][32][33][34] .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of pembrolizumab for the adjuvant treatment of resected high-risk stage III melanoma in the United States

Bensimon

Zhou

Jenkins

et al. 2019

Journal of Medical Economics

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Aims: To evaluate the cost-effectiveness of adjuvant pembrolizumab relative to observation alone following complete resection of high-risk stage III melanoma with lymph node involvement, from a US health system perspective. Materials and methods: A Markov cohort model with four health states (recurrence-free, locoregional recurrence, distant metastases, and death) was developed to estimate costs, life-years, and qualityadjusted life-years (QALYs) associated with pembrolizumab vs observation over a lifetime (46-year) horizon. Using a parametric multi-state modeling approach, transition probabilities starting from recurrence-free were estimated based on patient-level data from KEYNOTE-054 (NCT02362594), a direct head-to-head phase 3 trial. Post-recurrence transition probabilities were informed by real-world retrospective data and clinical trials in advanced melanoma. Health state utilities and adverse eventrelated disutility were derived from KEYNOTE-054 trial data and published literature. Costs of drug acquisition and administration, adverse events, disease management, and terminal care were estimated in 2018 US dollars. Deterministic and probabilistic sensitivity analyses were conducted to assess robustness. Results: Over a lifetime horizon, adjuvant pembrolizumab and observation were associated with total QALYs of 9.24 and 5.95, total life-years of 10.54 and 7.15, and total costs of $489,820 and $440,431, respectively. The resulting incremental cost-effectiveness ratios (ICERs) for pembrolizumab vs observation were $15,009/QALY and $14,550/life-year. Across the range of input values and assumptions tested in deterministic sensitivity analyses, pembrolizumab ranged from being a dominant strategy to having an ICER of $57,449/QALY vs observation. The ICER was below a willingness-to-pay threshold of $100,000/QALY in 90.2% of probabilistic simulations. Limitations: Long-term extrapolation of outcomes was based on interim results from KEYNOTE-054, with a median follow-up of 15 months. Conclusions: Based on common willingness-to-pay benchmarks, pembrolizumab is highly cost-effective compared with observation alone for the adjuvant treatment of completely resected stage III melanoma in the US. ARTICLE HISTORY

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“…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.…”

Section: Discussionmentioning

confidence: 67%

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

Tang

Shao

Wang

et al. 2022

Value in Health Regional Issues

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This study aimed to evaluate the cost-effectiveness of pembrolizumab compared with standard-of-care chemotherapy (paclitaxel 1 carboplatin [PC]) in patients with unresectable or metastatic melanoma after first-line treatment from a Chinese healthcare system perspective. Methods:We conducted a partitioned-survival model with a 1-week cycle length and a 20-year base-case time horizon. Piecewise parametric models were fitted to KEYNOTE-006 trial data to estimate progression-free survival and overall survival for pembrolizumab, and a network meta-analysis was used to estimate the clinical outcomes for standard of care. Quality-adjusted life-years (QALYs) were calculated using EQ-5D data from KEYNOTE-006, applying Chinese-specific utility tariffs. Costs included drug acquisition, administration, adverse events, and disease management, reflecting the Chinese pricing system. Chinese-specific disease management costs were estimated based on clinical opinion on health state resource use and chemotherapy-related adverse events. Costs and outcomes were discounted at 5% annually. Multiple deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results.Results: In the base-case analysis, the treatment of pembrolizumab is estimated to yield 2.63 life-years (LYs) and 2.24 QALYs at an incremental cost of U372 316.46 versus PC. The incremental costs per LY and per QALY were U141771.00 and U165 865.69, respectively, the latter being below a threshold of 3 times the per capita gross domestic product (￥193 932) in China, deemed as cost-effective according to the World Health Organization threshold. These findings were robust against a wide range of sensitivity analyses.Conclusions: Pembrolizumab is projected as cost-effective compared with PC in patients with unresectable or metastatic melanoma after first-line treatment in China.

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Cost-Effectiveness of Pembrolizumab for Unresectable Metastatic Melanoma After Progression with Ipilimumab in England

Cited by 8 publications

References 0 publications

Clinical and Economic Outcomes Associated with Treatment Sequences In Patients With BRAF -Mutant Advanced Melanoma

Clinical and Economic Outcomes Associated with Treatment Sequences In Patients With BRAF -Mutant Advanced Melanoma

Cost-effectiveness of pembrolizumab for the adjuvant treatment of resected high-risk stage III melanoma in the United States

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

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