OBJECTIVES: Metastatic melanoma is an aggressive disease and carries a poor prognosis; five-year relative survival rate for the metastatic melanoma is around 17%. The objective of this study was to evaluate the long-term cost-effectiveness of 4 different combinations of treatment strategies for the treatment of advanced melanoma.

METHODS: A Markov model containing three health states—progression free, progression, and death, was constructed with a cycle length of 3 months to simulate the lifetime progress of patients with metastatic melanoma and estimate cost and quality-adjusted life years (QALYs). The proportion of patients in each health state at each model cycle was calculated based on the relationship between the progression-free survival (PFS) and the overall survival (OS) data from the clinical trials. The economic evaluation was undertaken from the perspective of the Taiwan National Health Insurance. One-way sensitivity analyses and probabilistic sensitivity analysis were conducted to evaluate model uncertainty. 3.5% discount was applied to cost and QALY.

RESULTS: The results showed that chemotherapy in combination with best supportive care has the lowest CE ratio. Compared with the chemotherapy in combination with best supportive care, the use of Pembrolizumab for every 3 weeks followed by the second-line drug Ipilimumab produced an incremental cost effectiveness of NT$ 6,357,690. This is higher than 3GDP in Taiwan. The first line use of Nivolumab following by Ipilimumab and the first line use of Ipilimumab followed by Nivolumab were all dominated due to higher costs and lower QALYs than the use of Pembrolizumab every 3 weeks followed by second-line Ipilimumab. Our results concluded that 3 combination of immunotherapy are not cost-effectiveness at the willingness to pay level of NT$2,250,000.

CONCLUSIONS: We suggest further studies to provide more details on patient level information to improve the variation of parameter estimations.