Pcn75 Epidemiology, Mortality and Standard of Care in Advanced Breast Cancer - A Multiple Country Analysis

Abstract

Objectives: Since 2011, seven innovative drugs were commercialized for the treatment of metastatic melanoma (MM), significantly improving patient survival and cost in 1st line of treatment. With 52% of patients reaching a second line of treatment, the optimal sequence in patients with BRAF-mutated MM remains unclear. To inform policy makers about the value of these sequences, we performed a costeffectiveness analysis comparing sequences for BRAF-mutated MM in real life in France. Methods: Five sequences were compared: Anti-PD1-Bi-targeted therapies (BI-TT), BI-TT-Anti-PD1, Ipilimumab+Nivolumab-BI-TT, Mono-targeted therapies (MONO-TT)-BI-TT and MONO-TT-Anti-PD1. Clinical (efficacy and utility) and economic data were extracted from the prospective MelBase cohort, collecting individual data in 1,435 MM patients from 26 French hospitals, from MM diagnosis until death. To adjust for confounding effects and differences in patient characteristics among groups, the inverse probability of sequence weighted with a propensity score (PS) for multiple treatments was used. The PS was estimated using generalized boosted modeling. Costs were calculated from the health insurance perspective using French tariffs. Survival and costs were extrapolated using a multistate model, describing the 10-year course of the disease. Results: Among the 1435 patients, effectiveness was assessed on the 608 B-RAF mutated patients that were included between 2013 and 2019. As compared to the MONO-TT-BI-TT sequence (the less expensive), three sequences were excluded from the efficiency frontier as they were more expensive and less efficacy. Remains the Anti-PD1-BI-TT sequence, which was associated with additional costs of 66,343V and 0.7 additional quality-adjusted life years (QALYs), giving an incremental cost-effectiveness ratio of 94,776V/QALY. Considering the acceptability curve, at a threshold of 150,000V, Mono-TT-Anti-PD1 has nearly 100% chance of being efficient, and at 300,000V Anti-PD1-Bi-TT has a 60% chance of being efficient. Conclusions: For patients with BRAF-mutated MM, Anti-PD1-BI-TT and MONO-TT-Anti-PD1 seem to be most cost-effective sequences, in France based on observational data.