Cost-Utility Analysis of Nivolumab in Adjuvant Treatment of Melanoma in France.

Cost-Utility Analysis of Nivolumab in Adjuvant Treatment of Melanoma in France.

Publication date: Sep 13, 2020

The aim of the current study is to estimate the cost-effectiveness of adjuvant treatment with nivolumab relative to clinically relevant comparators in adult patients with melanoma with lymph node involvement or metastatic disease who have undergone complete resection from a French societal perspective.

The comparators were observation, low-dose interferon and pembrolizumab. A subgroup analysis was carried out in patients with BRAF mutation, adding dabrafenib plus trametinib. A three-state partitioned survival model was developed to project costs and health benefits over a 20-year time horizon. Extrapolation for recurrence-free survival (RFS) and overall survival (OS) was carried out using spline-based models. Because of the immaturity of OS data in pivotal trials for nivolumab and pembrolizumab, a predictive model of OS treatment effect based on RFS effect was developed using a correlation equation. Health state utilities and adverse events disutilities were derived from the CheckMate 238 trial and literature. Costs were estimated in 2019 euros. The model’s primary outcome was efficiency frontier. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of results.

Observation, low-dose interferon and nivolumab were on the efficiency frontier. The incremental cost-utility ratio of nivolumab versus low-dose interferon (closest therapy on the efficiency frontier) was ?37,886/quality-adjusted life year (QALY). Probabilistic sensitivity analysis reported an 80% probability of nivolumab being a cost-effective strategy for a willingness-to-pay threshold of ?52,000/QALY. In the subgroup with BRAF mutation, the efficiency frontier was not changed by the addition of dabrafenib plus trametinib.

Nivolumab is a cost-effective strategy as adjuvant treatment in adult patients with surgically resected melanoma in France.

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Concepts Keywords
Adjuvant Cancer treatments
BRAF Clinical medicine
Correlation RTT
Extrapolation Antineoplastic drugs
France Breakthrough therapy
French Bristol-Myers Squibb
Horizon Sulfonamides
Interferon Melanoma
Lymph Node Nivolumab
Melanoma Dabrafenib
Metastatic Pembrolizumab
Mutation
Probabilistic
Probability
QALY
Resection
Robustness
Spline
Subgroup

Semantics

Type Source Name
drug DRUGBANK Nivolumab
disease MESH Melanoma
pathway KEGG Melanoma
drug DRUGBANK Pembrolizumab
drug DRUGBANK Dabrafenib
drug DRUGBANK Trametinib
disease MESH recurrence
drug DRUGBANK Coenzyme M
disease MESH noma
disease MESH metastases
disease MESH syndrome
disease MESH death
drug DRUGBANK Ipilimumab
drug DRUGBANK Esomeprazole
drug DRUGBANK Ilex paraguariensis leaf
drug DRUGBANK Bismuth subgallate
drug DRUGBANK Trestolone
drug DRUGBANK L-Lysine
disease MESH uncertainty
disease MESH renal
disease MESH carcinoma
disease MESH cancer
pathway REACTOME Reproduction
drug DRUGBANK Natural alpha interferon
drug DRUGBANK Ranitidine
disease MESH Stroke
disease MESH atrial fibrillation
drug DRUGBANK Apixaban
drug DRUGBANK Dabigatran
drug DRUGBANK Acetylsalicylic acid
disease MESH sclerosis
disease MESH diagnosis
drug DRUGBANK Fenamole
disease MESH Lung Cancer

Original Article

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