COST-EFFECTIVENESS OF NIVOLUMAB IN COMBINATION WITH IPILIMUMAB IN FIRST-LINE TREATMENT OF ADVANCED MELANOMA IN SWEDEN- ANALYSIS USING 28-MONTH OVERALL SURVIVAL FROM CHECKMATE 067
Author(s)
Baker T1, Paly VF1, Sabater J2, Holmberg C3, Hultberg M4, Lundström J3, Minacori R5, Chirita O6
1ICON, New York, NY, USA, 2Bristol-Myers Squibb, Princeton, NJ, USA, 3Bristol-Myers Squibb, Bromma, Sweden, 4PAREXEL International, Stockholm, Sweden, 5PAREXEL International, London, UK, 6Bristol-Myers Squibb, Uxbridge, Middlesex, UK
OBJECTIVES: The objective of this study was to evaluate the cost-effectiveness of nivolumab in combination with ipilimumab (Nivo+Ipi) compared to current therapeutic alternatives in first-line treatment of patients with advanced melanoma regardless of biomarker status in Sweden from a payer perspective using recently reported 28-month survival data from the CheckMate 067 Phase III trial. METHODS: A three-state partitioned survival model was developed from projections of overall survival and progression free survival based on a network meta-analysis which considers time-varying hazard ratios to estimate accrued quality-adjusted survival and costs over a 15-year time horizon. The analysis considered nivolumab monotherapy as the key comparator but also included ipilimumab, pembrolizumab, dabrafenib, dabrafenib + trametinib, vemurafenib + cobimetinib, and dacarbazine. Drug acquisition, administration, follow-up, subsequent therapy and adverse event costs were obtained via published sources and expert input. Adverse event frequencies were collected from the Checkmate 067 trial and published literature. Utility weights were estimated from the Checkmate 067 trial, based on UK tariffs. A 3% discount rate was applied to costs and utilities. Results were presented as incremental cost-utility ratios (ICURs) RESULTS: Nivo+Ipi was projected to have the greatest accrued survival among the competing treatments with 5.07 LYs and 3.93 QALYs and also the highest total costs (1,941,848 kr). The comparisons vs. nivolumab, resulted in an ICUR of 319,045 kr. Pairwise ICURs for Nivo+Ipi vs. other treatments ranged from 112,002 kr per QALY (vs. pembrolizumab) to 578,393 kr per QALY (vs. dacarbazine). CONCLUSIONS: The analysis highlighted that Nivo+Ipi is associated with the highest gain in quality-adjusted survival accompanied by higher costs compared to the current therapeutic alternatives. ICUR results indicated that Nivo+Ipi is likely to be a cost-effective option in the first-line treatment of advanced melanoma in Sweden.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PCN178
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology, Sensory System Disorders