OBJECTIVES

Nivolumab (NIVO) and dabrafenib + trametinib (DAB+TRAM) are approved by the European Medicines Agency as adjuvant treatments for resected melanoma. This study compared the cost per recurrence-free survivor and cost per recurrence-free life-year (RFLY) of adjuvant NIVO vs. DAB+TRAM among patients with stage IIIB/C BRAF-mutant cutaneous melanoma in Spain.

METHODS

Recurrence-free survival (RFS) rates and RFLYs were estimated using a matching-adjusted indirect comparison of NIVO and DAB+TRAM based on the CheckMate 238 and COMBI-AD trials. The analysis was performed from the Spanish National Health System (SNHS) perspective. The total treatment costs at 12, 24, and 36 months were estimated based on drug acquisition cost for hospitals in SNHS. The cost per recurrence-free survivor and cost per RFLY were calculated by dividing the total treatment costs by RFS rates and RFLYs of treatment. All costs were presented in 2020 Euros.

RESULTS

The RFS rates for NIVO and DAB+TRAM were 71% (95% CI, 64%–80%) and 86% (83%–90%) at 12 months, 64% (56%–73%) and 63% (58%–69%) at 24 months, and 59% (51%–69%) and 54% (49%–60%) at 36 months, respectively. At 12 months, the cost per recurrence-free survivor for NIVO (66,196€; 95% CI, 59,238€–73,971€) was lower than for DAB+TRAM (97,382€; 93,054€–100,902€); this difference increased at 24 months (73,884€ vs 132,934€, respectively) and at 36 months (79,608€ vs 155,090€). Similarly, the cost per RFLY was lower for NIVO than for DAB+TRAM at 12 months (56,805€ vs 88,029€), 24 months (31,446€ vs 49,746€), and 36 months (22,278€ vs 37,011€).

CONCLUSIONS

The results indicate that NIVO is associated with a substantially lower cost per recurrence-free survival and cost per RFLY. By these measures, NIVO is more cost-effective than DAB+TRAM as adjuvant therapy for stage IIIB/C BRAF-mutant melanoma.