OBJECTIVES: In June 2018, the European medicines agency approved nivolumab for the adjuvant treatment of adults with melanoma with lymph node involvement. Prior to its approval, the standard of care in most European countries was a watch and wait strategy. In an indirect treatment comparison, nivolumab demonstrated significant recurrence free survival benefit vs placebo (proxy for watch and wait). This study compared melanoma-specific costs following treatment with nivolumab or placebo from the United Kingdom (UK) perspective.

METHODS: Individual patient data from CheckMate 238 (3 year database lock) and EORTC 18071 (7 year database lock) were used to derive the resource utilisation associated with nivolumab and placebo. A propensity-matched analysis was conducted using inverse probability weight regression to balance the baseline characteristics across the treatments and calculate costs for the adjusted population. Resource utilisation data including drug resources (initial, subsequent, and concomitant treatment) and non-drug resources (diagnostics/non-diagnostic procedures, healthcare visits, hospitalisation, lab tests, and surgeries) were extracted from the studies. The most recent cost data from the UK were applied to the resource utilisation frequencies. The follow up time over which costs were calculated for placebo patients was matched with the nivolumab follow up time.

RESULTS: The total costs/patient incurred were £121,529 with nivolumab and £129,337 with placebo. The higher costs for the placebo population compared with the nivolumab population was driven by subsequent treatment costs, £118,966 vs £60,491, accounting for 92% and 50% of total costs respectively. The majority (89%) of nivolumab costs/patient occurred in the first two years compared with 56% for the placebo population.

CONCLUSIONS: The results of this analysis shows that the placebo group is associated with higher healthcare resource use costs compared with the nivolumab group, indicating that nivolumab treatment cost is offset by the benefit of preventing recurrence thereby reducing subsequent treatment costs.