Pcn208 Cost-Effectiveness of Nivolumab for the Adjuvant Treatment of Patients With Melanoma With Involvement of Lymph Nodes or Metastatic Disease Who Have Undergone Complete Resection: An Analysis From a Swiss Healthcare System Perspective

Oniangue-Ndza, C.; Strittmatter, Gerhard; Orsini, I.; Teitsson, S; Augusto, Margarida; Amadi, A.

doi:10.1016/j.jval.2019.09.404

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…presented an alternative surrogate based on systematic research of available literature. On this basis, a series of country-specific costeffectiveness calculations for the relationship nivolumab vs. observation were presented as congress papers (for Spain [73], Greece [74], the National Health Service (UK) [72], Switzerland [75]). Also as congress papers, a comparison of the combination therapy dabrafenib/trametinib vs. observation for Canada [76] with observation and a comparison of dabrafenib/trametinib with pembrolizumab for Brazil [77] were presented.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant treatment of high-risk melanoma – cost-effectiveness analysis of treatment options for BRAF 600 mutated tumors

Wahler

Müller²,

Fuchs

et al. 2022

Health Econ Rev

View full text Add to dashboard Cite

Introduction Until recently, adjuvant treatment options for higher stage resectable cutaneous melanoma were limited. Two studies with a similar set-up, published 2017, led to registration of targeted therapy for BRAF-mutated melanoma with dabrafenib and trametinib as well as of the immunotherapy with nivolumab irrespective of BRAF-mutation status. Both options have been positively assessed in Germany since 2019 for the adjuvant treatment of BRAF-V600 mutated melanoma. This study evaluates the cost-effectiveness of both treatment alternatives (dabrafenib/trametinib and nivolumab) against observation as a comparative therapy from the perspective of German statutory health funds. Methods Partitioned survival analysis based on published survival curves for the investigated treatment options was used for a cohort model for the health states relapse free survival, progression, and death. The partitioned survival analysis approach was based on the survival curves published for the key studies Combi AD and Checkmate-238. The modelling was performed for the remaining lifetime for a cohort with starting age of 50 years. For extrapolation of the survival curves, convergence to general population mortality rates was assumed in the long term. Within the progression state, a Markov model uses three levels of progressions (locoregional, distant metastases with 1st and 2nd line treatment). Lifetime treatment costs were calculated using the German statutory health fund reimbursement scheme. Quality adjusted life years (QALYs) associated to the health states were adopted from previously published utilities based on the Combi AD study. Results The treatment with dabrafenib/trametinib yielded an increase in quality adjusted life years of 2.28 QALY at an incremental lifetime cost of 86.1 T€. The incremental cost effectiveness ratio of dabrafenib/trametinib and nivolumab was comparable with 37.8 T€/QALY and 30.0 T€/QALY, respectively. Several sensitivity analyses proved the result to be insensitive. General model parameters like discount rate and length of the time horizon had stronger influence. For nivolumab, the model showed lower discounted lifetime costs (118.1 T€) compared to dabrafenib/trametinib [155.1 T€], associated with a lower gain in QALYs (1.64 years) compared to observation. Conclusion Both dabrafenib/trametinib and nivolumab turned out to be cost effective within internationally accepted Incremental Cost Effectiveness Ratio (ICER) thresholds with comparable cost effectiveness ratios.

show abstract