OBJECTIVES : CheckMate 067 randomized clinical trial data has shown that a combination of immunology drugs, nivolumab (NIVO) and ipilimumab (IPI), results in longer progression-free and overall survival in advanced melanoma patients, compared with either monotherapy. We assessed the implications of these clinical benefits on costs associated with these treatments. The objective of this study was to evaluate and compare direct healthcare costs in France over 60 months for patients initiating treatment with NIVO+IPI against those initiating (i) NIVO monotherapy and (ii) IPI monotherapy from a societal costs perspective.

METHODS : Individual patient-level data for European patients in the CheckMate 067 trial were used to derive the resources utilized by patients. All melanoma-specific resources, both drug and non-drug, were considered in this evaluation. Unit costs for these resources were obtained from external sources. The mean cost per surviving patient in the respective regimen cohort each month was computed and aggregated.

RESULTS : Total melanoma-specific healthcare costs incurred by the NIVO+IPI treated cohort (€230k) were 16% lower compared to the NIVO cohort (€272k) and 10% lower compared to IPI cohort (€255k). The cost advantage by the NIVO+IPI cohort is observed from month 22 (vs. NIVO cohort) and month 38 (vs. IPI cohort) and widens each month thereafter. The costs associated with subsequent melanoma therapies were greatest for the IPI cohort (€179k, 70% of total costs) and lowest for the NIVO+IPI regimen cohort (€64k, 28%).

CONCLUSIONS : Despite the acquisition cost of two index drugs, costs incurred by the NIVO+IPI cohort over 60 months are lower than costs incurred by patients initiating treatment with either IPI or NIVO alone. The higher upfront costs of the NIVO+IPI regimen are offset by lower post-progression costs, as patients receiving NIVO+IPI enjoy a longer duration of response, delayed progression and consequently, reduced usage of subsequent melanoma therapies.