Cost-Effectiveness of Nivolumab (NIVO) and NIVO in Combination With Ipilimumab (IPI) in First-Line Treatment of Advanced Melanoma in Colombia: Analysis Using 78-Month Overall Survival From CheckMate 067

OBJECTIVES: The objective of this study was to evaluate the cost-effectiveness of NIVO or NIVO+IPI compared to current therapeutic alternatives in first-line treatment of patients with advanced melanoma in Colombia from a healthcare payer perspective, using 78-month survival data from the CheckMate 067 Phase III trial.

METHODS: A three-state partitioned survival model was developed from projections of overall survival and progression-free survival based on a network meta-analysis which considered time-varying hazard ratios to estimate costs, life-years (LYs), and quality-adjusted LYs (QALYs) over a 30-year time horizon. The analysis considered NIVO or NIVO+IPI as the key intervention but also included pembrolizumab (PEM) and dabrafenib+trametinib (DAB+TRAM). The model incorporated baseline patient characteristics (age, weight, background mortality) from Colombian sources. Utility weights were estimated from the Checkmate 067 trial, based on UK tariffs. All unit costs (2023 COL$) were Colombian-specific; costs and health outcomes were discounted by 5% annually, per IETS guidelines. Results were presented as incremental cost-utility ratios (ICURs). Robustness of the results was evaluated through extensive sensitivity and scenario analyses.

RESULTS: NIVO was associated with cost savings (COL$2,457,700,118 and COL$69,259,660), higher LYs (3.33 vs. 2.28 and 3.01), and higher QALYs (2.62 vs. 1.76 and 2.36) compared to DAB+TRAM and PEM, respectively, resulting in NIVO dominating DAB+TRAM and PEM. NIVO+IPI was associated with higher LYs (4.09 vs. 2.28 and 3.01), and higher QALYs (3.19 vs. 1.76 and 2.36) compared to DAB+TRAM and PEM, respectively, resulting in NIVO+IPI dominating DAB+TRAM (cost savings of COL$2,385,137,437) and having an ICUR of COL$3,986,610 per QALY when compared to PEM (incremental costs of COL$3,303,021). The model results were robust to alternative modeling inputs and assumptions.

CONCLUSIONS: Based on this analysis, NIVO or NIVO+IPI are cost-effective or dominant treatment options compared to DAB+TRAM and PEM for the first-line treatment of advanced melanoma patients in Colombia.