Quality of life and cost-effectiveness of interferon-alpha in malignant melanoma: results from randomised trial

Abstract

A definitive conclusion regarding the value of low-dose extended duration adjuvant interferon-alpha therapy in the treatment of malignant melanoma is only possible once data on health-related quality of life (HRQoL) and costs have been considered. This trial randomised 674 patients to interferon alpha-2a (3 megaunits three times per week for 2 years or until recurrence) or placebo. Health-related quality of life (QoL) was to be assessed up to 60 months using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30. Data for the economic analysis, including cost information and the EQ-5D were also collected. Patients in the observation (OBS) group had significantly better mean follow-up quality of on five dimensions of the EORTC QLQ-C30 functional scales: role functioning (P ¼ 0.033), emotional functioning (P ¼ 0.003), cognitive functioning (P ¼ 0.001), social functioning (P ¼ 0.003) and global health status (P ¼ 0.001). Patients in the OBS group had significantly better mean follow-up symptom scores on seven dimensions of the EORTC QLQ-C30 V1 symptom scales. Economic data showed that costs were d3066 higher in the interferon group and produces an incremental cost per quality-adjusted life year of d41 432 at 5 years. The results show that interferon has significant effects on QoL and symptomatology and is unlikely to be cost-effective in this patient group in the UK.

The Role of the EQ-5D in the Economic Evaluation of Dermatological Conditions and Therapies

“…The literature search identified 19 articles and 1 abstract (published between 2003 and 2011), in which were described 7 cost-of-illness analyses [9,10,11,12,13,14,15], 1 cost-effectiveness analysis [16] and 13 cost-utility analyses [16,17,18,19,20,21,22,23,24,25,26,27,28]. …”

Societal preference values for advanced melanoma health states in the United Kingdom and Australia

“…Specifically, decreases in quality-of-life during IFN-a treatment for advanced melanoma were offset by reduced risk of recurrence and mortality when vignette-based utilities were applied (Kilbridge et al, 2002;Crott, 2004;Crott et al, 2004). In contrast, IFN was only marginally better in treating melanoma than was BSC when generic EQ-5D utilities were used (Dixon et al, 2006).…”

“…Health status utility assessments enable the quantification of preferences for health outcomes and the estimation of qualityadjusted life expectancy. Utility measurement in melanoma to date has primarily focused on toxicities associated with interferon (IFN) therapy (Kilbridge et al, 2001;Dixon et al 2006). No studies have obtained utilities for a broader set of health states that capture both the intended (clinical response) and unintended (toxicity) effects of available treatments for advanced melanoma.…”

Malignant Melanoma S3‐Guideline “Diagnosis, Therapy and Follow‐up of Melanoma”

“…Patients experience a deterioration of QL around the time of primary diagnosis, disease progression, and during systemic therapy [504,513,518,652,660,668,674,675]. Predisposing factors regarding QL progression have been insufficiently validated, albeit some studies have indicated a negative correlation with female gender, preexisting depression, lower social status, and lack of coping [655,676].…”