OBJECTIVES:

Numerous immune checkpoint inhibitors (ICIs) are currently available and multiple cost-effectiveness analyses (CEAs) have been conducted. The purpose of this study was to conduct a systematic review on the cost-effectiveness of ICIs for advanced melanoma.

METHODS:

A literature search was identified in PubMed and EMBASE using ICI product names and “cost-effectiveness.” Studies were evaluated based on the following inclusion criteria: 1) patient population was advanced melanoma; 2) evaluated one or more ICI agents; 3) were original investigations, not review articles; 4) was an economic evaluation; and 5) published in English. Data was abstracted including: methods; country; interventions; perspective; time horizon; model structure; sources of data; and major findings. Quality of reporting was assessed by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).

RESULTS:

Ten CEAs evaluating ICIs for advanced melanoma were identified. One economic evaluation was a cost-benefit analysis, one was a cost-effectiveness with life-months as the measure of effectiveness, and eight were cost-quality-adjusted life year (QALY) studies. For cost-utility studies, utility values were derived from generic preference base (i.e., EuroQol 5-dimension tool), direct preference base (i.e., standard gable and time trade off), and disease specific tools (i.e., European organization for research and treatment of cancer). Seven studies used a health payer perspective, while two studies used a societal perspective. However, societal-perspective studies did not include indirect costs. Studies of ICI relative to chemotherapy had ICER values less than $90,871 per quality-QALY. Among three ICI, pembrolizumab was more cost-effective than nivolumab and ipilumumab, and nivolumab is more cost-effective than ipilumumab.

CONCLUSIONS:

This systematic review of CEAs identified 10 studies involving ICIs. Across all studies using cost/QALY outcomes, the ICER values were less than $90,871 per QALY. Thus, based on a threshold of $100,000/QALY, ICIs appear to be cost-effective relative to chemotherapy for advanced melanoma.