COST-EFFECTIVENESS OF NIVOLUMAB (NIVO) COMBINED WITH IPILIMUMAB (IPI) COMPARED WITH NIVO AND IPI MONOTHERAPIES IN THE FIRST-LINE TREATMENT OF ADVANCED MELANOMA IN THE UNITED STATES- ANALYSIS USING 28-MONTH OVERALL SURVIVAL (OS) DATA FROM CH ...
Author(s)
Baker T1, Paly VF1, Sabater J2, Gupte-Singh K2, Beyhaghi H2, Kotapati S2, Rao S2, Briggs A3
1ICON, New York, NY, USA, 2Bristol-Myers Squibb, Princeton, NJ, USA, 3University of Glasgow, Glasgow, Scotland, UK
OBJECTIVES: The objective of this study was to evaluate the cost-effectiveness of NIVO+IPI versus NIVO and IPI monotherapies in the first-line treatment of patients with advanced melanoma from a US payer perspective, using recently reported 28-month OS data from the CheckMate 067 trial. METHODS: This three-state partitioned survival model was developed from projections of OS and progression-free survival (PFS) to estimate accrued quality-adjusted life-years (QALYs), drug acquisition, follow-up, and toxicity costs over a life span time horizon (30 years). While previous models were informed by network meta-analysis methods, our analysis used survival extrapolations based on within-trial parametric modeling to test model sensitivity. Parametric fits were selected based on statistical and visual goodness of fit and the clinical plausibility and consistency of the OS and PFS combinations (NIVO+IPI: Gompertz for OS and PFS; both NIVO and IPI: log normal for OS and generalized gamma for PFS). General population mortality was also applied. Adverse-event frequencies and utility weights were obtained from CheckMate 067, and all costs from expert input and publically available sources/literature. Incremental cost-utility ratios (ICURs) for NIVO+IPI were estimated. A 3.5% discount rate was applied to costs ($US 2016) and utilities. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Using the best fitting curves, NIVO+IPI was estimated to have 2.46 and 4.23 incremental QALYs and $88,344 and $149,903 incremental costs over NIVO and IPI monotherapies, respectively. The ICURs for NIVO+IPI were $35,893 versus NIVO and $35,431 versus IPI. These findings were found to be consistent in the deterministic and probabilistic sensitivity analyses. CONCLUSIONS: This analysis highlights that NIVO+IPI combination has a longer survival than either monotherapy and, when combined with the incremental costs associated with NIVO+IPI, the ICURs indicate that it is likely to be a cost-effective option compared with monotherapy.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PCN135
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology