Cost-Effectiveness Analysis of Avelumab for Treatment-Experienced and Treatment-Naïve Patients with Metastatic Merkel CELL Carcinoma in Taiwan
Author(s)
Palencia R1, Lin AY2, Chang HC2, Goh C2, Chou P3, Kuo K3, Hsu J4, Chang WC5
1Merck KGaA, Darmstadt, HE, Germany, 2Merck Ltd a business of Merck KGaA, Darmstadt, Germany, Taipei, TPQ, Taiwan, 3IQVIA Solutions Taiwan Ltd, Taipei, Taiwan, 4School of Pharmacy, National Cheng Kung University, Tainan, Taiwan, 5Internal Medicine, Division of Hematology-Oncology, Chang Gung Memorial Hospital, Linkuo, Taiwan
OBJECTIVES : To confirm the cost-effectiveness of avelumab versus chemotherapy for treating patients with metastatic Merkel Cell Carcinoma (mMCC) in Taiwan with a new version of an economic model. METHODS : A 3-state partitioned-survival model1 that assesses lifetime costs and effects of avelumab and chemotherapy regimens was adapted in excel. The new model uses long-term follow-up data for treatment-experienced (n=88) and treatment-naïve patients (n=112). The data were obtained from the JAVELIN Merkel 200 trial and observational studies for avelumab and chemotherapy regimens, respectively. The model was adapted using the Taiwanese National Health Insurance Administration (NHIA) perspective. Costs were identified from specific sources such as National Health Insurance Administration Medication Online,2 National Health Insurance Administration Medical Service Online,3 and National Health Insurance Annual Medical Expenses Reports.4 Aligned with the National Institute of Health Technology Assessment (NIHTA) recommendations,5 the results are presented as incremental cost-effectiveness ratios (ICERs) as cost per life year (LY) gained and cost per quality-adjusted life year (QALY) gained. Annual discount rates of 3% for both costs and QALYs were considered. RESULTS : The ICERs for avelumab versus chemotherapy were NT$494,600 per LY and NT$811,437 per QALY gained for treatment-experienced mMCC patients and NT$827,438 per LY and NT$1,314,308 per QALY gained for treatment-naïve mMCC patients, respectively. These ICERs fall below the threshold of 2 times the Taiwanese gross domestic product (GDP) per capita. The ICER for treatment-experienced mMCC patients has even gone down by 12% from a previous version of the model using less mature data. Both probabilistic and deterministic analyses confirmed the results. CONCLUSIONS The analyses with more mature long-term follow-up data from the JAVELIN Merkel 200 continue to demonstrate that avelumab is a cost-effective option versus chemotherapy in treatment-experienced and treatment-naïve mMCC patients in Taiwan. The results confirm the recommendation of the NIHTA to treat mMCC patients with avelumab.
Code
PCN28