EARLY ECONOMIC EVALUATION OF ADJUNCTIVE BLOOD-BRAIN BARRIER MODULATION IN MELANOMA BRAIN METASTASES: A UK NHS PERSPECTIVE
Author(s)
Ankur Singh Chauhan, MPH, MSc, PhD1, Nicola R. Sibson2, Sandra Campbell, PhD3, Simon Lord, BM BCh, DPhil3, James Rose, BSc, PhD1, Mamta Bajre, MSc1.
1Health Innovation Oxford and Thames Valley, Oxford, United Kingdom, 2University of Oxford, United Kingdom, 3Department of Oncology, University of Oxford, Oxford, United Kingdom.
1Health Innovation Oxford and Thames Valley, Oxford, United Kingdom, 2University of Oxford, United Kingdom, 3Department of Oncology, University of Oxford, Oxford, United Kingdom.
OBJECTIVES: Melanoma has one of the highest propensities for central nervous system spread, with brain metastases occurring in approximately 40%-60% of patients with advanced disease. This early-stage economic evaluation assessed the cost-effectiveness of adding mutant tumour necrosis factor (mutTNF), a TNFR1-selective blood-brain-barrier modulator, to standard NHS management pathways for melanoma brain metastases (MBM).
METHODS: A 1-year decision-tree model compared standard management with standard management plus mutTNF from an NHS perspective. Pathways reflected systemic therapy alone, systemic therapy plus surgery, and systemic therapy plus radiotherapy, with systemic treatment classes including immunotherapy, BRAF/MEK targeted therapy, and chemotherapy. Model inputs were informed by published literature, NICE appraisals, NHS reference costs, BNF/MIMS prices, and preclinical and translational evidence. Deterministic base-case, scenario, price-threshold, subgroup, probabilistic sensitivity analysis (PSA; 100,000 Monte Carlo simulations), and EVPI/EVPPI analyses were conducted at GBP30,000/QALY.
RESULTS: In the base case, standard management cost GBP135,730 and generated 0.7288 QALYs; standard management plus mutTNF cost GBP135,793 and generated 0.7911 QALYs. The incremental cost was GBP63 and incremental effectiveness was 0.0623 QALYs, giving an ICER of GBP1,005/QALY. Subgroup analyses demonstrated consistent cost-effectiveness across treatment pathways, with ICERs remaining below GBP5,400/QALY. The conservative benefit scenario (+0.03 QALYs) remained cost-effective (ICER GBP1,937/QALY). mutTNF remained cost-effective up to approximately GBP1,842 per dose. In PSA, mutTNF generated higher expected net monetary benefit than standard management, was optimal in 58.1% of simulations, and had an incremental NMB of GBP1,807 per patient. EVPI was GBP2,800 per patient.
CONCLUSIONS: Under the model assumptions and available preclinical evidence, mutTNF was associated with improved QALYs and favourable cost-effectiveness across MBM treatment pathways despite high background systemic therapy costs. Deterministic, probabilistic, and value-of-information analyses supported its potential as a low-cost, delivery-enhancing adjunct to standard care. Prospective studies should prioritise intracranial response, quality of life, and dosing assumptions to refine economic estimates and inform future NHS decision-making.
METHODS: A 1-year decision-tree model compared standard management with standard management plus mutTNF from an NHS perspective. Pathways reflected systemic therapy alone, systemic therapy plus surgery, and systemic therapy plus radiotherapy, with systemic treatment classes including immunotherapy, BRAF/MEK targeted therapy, and chemotherapy. Model inputs were informed by published literature, NICE appraisals, NHS reference costs, BNF/MIMS prices, and preclinical and translational evidence. Deterministic base-case, scenario, price-threshold, subgroup, probabilistic sensitivity analysis (PSA; 100,000 Monte Carlo simulations), and EVPI/EVPPI analyses were conducted at GBP30,000/QALY.
RESULTS: In the base case, standard management cost GBP135,730 and generated 0.7288 QALYs; standard management plus mutTNF cost GBP135,793 and generated 0.7911 QALYs. The incremental cost was GBP63 and incremental effectiveness was 0.0623 QALYs, giving an ICER of GBP1,005/QALY. Subgroup analyses demonstrated consistent cost-effectiveness across treatment pathways, with ICERs remaining below GBP5,400/QALY. The conservative benefit scenario (+0.03 QALYs) remained cost-effective (ICER GBP1,937/QALY). mutTNF remained cost-effective up to approximately GBP1,842 per dose. In PSA, mutTNF generated higher expected net monetary benefit than standard management, was optimal in 58.1% of simulations, and had an incremental NMB of GBP1,807 per patient. EVPI was GBP2,800 per patient.
CONCLUSIONS: Under the model assumptions and available preclinical evidence, mutTNF was associated with improved QALYs and favourable cost-effectiveness across MBM treatment pathways despite high background systemic therapy costs. Deterministic, probabilistic, and value-of-information analyses supported its potential as a low-cost, delivery-enhancing adjunct to standard care. Prospective studies should prioritise intracranial response, quality of life, and dosing assumptions to refine economic estimates and inform future NHS decision-making.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE228
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Biologics & Biosimilars, Genetic, Regenerative & Curative Therapies, No Additional Disease & Conditions/Specialized Treatment Areas, Oncology