Cost-Effectiveness Analysis of Nivolumab Plus Relatlimab (NIVO+RELA) Versus Current Standard of Care (SOC) for Patients with Unresectable or Metastatic Melanoma in Canada


Mameri E1, McDonald L2, Villeneuve J3, Ejzykowicz F4, Baginska B5, Tokarz A5, Yates G6, Cai R7
1Bristol-Myers Squibb, St Laurent, QC, Canada, 2Bristol Myers Squibb, Uxbridge, Uxbridge, UK, 3Bristol Myers Squibb, St. Laurent, QC, Canada, 4Bristol Myers Squibb, West Windsor, NJ, USA, 5Parexel, Krakow, Poland, 6Parexel International, London, LON, UK, 7Parexel International, Gouda, ZH, Netherlands

OBJECTIVES: To evaluate the cost-effectiveness of fixed-dose combination NIVO+RELA versus SOC for unresectable or metastatic melanoma (including immunotherapies [IOs]: NIVO, pembrolizumab [PEMBRO], nivolumab+ipilimumab [NIVO+IPI], IPI, and BRAF/MEK inhibitors: vemurafenib+cobimetinib [VEM+COBI], dabrafenib+trametinib [DAB+TRAM] and encorafenib+binimetinib [ENCO+BINI]) from a healthcare payer perspective in Canada.

METHODS: A three-state partitioned-survival model was developed. Parametric and piecewise models were fitted to the overall survival (OS) and progression-free survival (PFS) data from the NIVO+RELA and NIVO arms of the all-comers in RELATIVITY-047. To incorporate other comparators, time-varying hazard ratios based on a fractional polynomial network meta-analysis were applied to the modelled PFS and OS NIVO curves from RELATIVITY-047. Costs of drugs, disease management, adverse events, and subsequent treatments were sourced from Canadian official websites (year 2023). Health-state specific utilities were derived from the EQ-5D data collected in RELATIVITY-047 using the Canadian values. A discount rate of 1.5% was applied for costs and outcomes. Model outcomes were average quality-adjusted life years (QALYs), costs, and sequential incremental cost-utility ratios (ICURs) over 25 years. The base case was probabilistic with 4,000 Monte Carlo iterations. Scenario analyses tested robustness of results to modelling assumptions.

RESULTS: NIVO+RELA generated higher QALYs compared to other IOs; total QALYs were 5.74, 4.93, 3.40, 6.38, and 6.89 for NIVO, PEMBRO, IPI, NIVO+IPI, and NIVO+RELA, respectively. Total costs were $235,576, $268,007, $268,964, $274,002, and $371,036, respectively. In the sequential comparison, PEMBRO and IPI were dominated by NIVO, the ICURs were $60,894/QALY for NIVO+IPI versus NIVO and $187,138/QALY for NIVO+RELA versus NIVO+IPI. NIVO+RELA dominated all BRAF/MEK inhibitors, generating higher incremental QALYs (2.86-3.74) with cost savings ($340,334-$718,183). The results were consistent across a range of scenario analyses.

CONCLUSIONS: NIVO+RELA is expected to be a life-extending and cost-effective new therapy compared to SOC treatments for unresectable or metastatic melanoma in Canada.

Conference/Value in Health Info

2024-05, ISPOR 2024, Atlanta, GA, USA

Value in Health, Volume 27, Issue 6, S1 (June 2024)




Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis


Drugs, Oncology

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