The cost-effectiveness of nivolumab monotherapy for the treatment of advanced melanoma patients in England

Yang Meng, Nadine Hertel, John Ellis, Edith Morais, Helen Johnson, Zoe Philips, Neil Roskell, Andrew Walker, Dawn Lee

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Nivolumab was the first programmed death receptor 1 (PD-1) immune checkpoint inhibitor to demonstrate long-term survival benefit in a clinical trial setting for advanced melanoma patients.

OBJECTIVE: To evaluate the cost effectiveness of nivolumab monotherapy for the treatment of advanced melanoma patients in England.

METHODS: A Markov state-transition model was developed to estimate the lifetime costs and benefits of nivolumab versus ipilimumab and dacarbazine for BRAF mutation-negative patients and versus ipilimumab, dabrafenib, and vemurafenib for BRAF mutation-positive patients. Covariate-adjusted parametric curves for time to progression, pre-progression survival, and post-progression survival were fitted based on patient-level data from two trials and long-term ipilimumab survival data. Indirect treatment comparisons between nivolumab, ipilimumab, and dacarbazine were informed by these covariate-adjusted parametric curves, controlling for differences in patient characteristics. Kaplan-Meier data from the literature were digitised and used to fit progression-free and overall survival curves for dabrafenib and vemurafenib. Patient utilities and resource use data were based on trial data or the literature. Patients are assumed to receive nivolumab until there is no further clinical benefit, assumed to be the first of progressive disease, unacceptable toxicity, or 2 years of treatment.

RESULTS: Nivolumab is the most cost-effective treatment option in BRAF mutation-negative and mutation-positive patients, with incremental cost-effectiveness ratios of £24,483 and £17,362 per quality-adjusted life year, respectively. The model results are most sensitive to assumptions regarding treatment duration for nivolumab and the parameters of the fitted parametric survival curves.

CONCLUSIONS: Nivolumab is a cost-effective treatment for advanced melanoma patients in England.

Original languageEnglish
Pages (from-to)1163-1172
Number of pages10
JournalThe European Journal of Health Economics
Volume19
Issue number8
Early online date9 Mar 2018
DOIs
Publication statusPublished - Nov 2018

Keywords

  • Age Factors
  • Aged
  • Antineoplastic Agents, Immunological/administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols/economics
  • Cost-Benefit Analysis
  • Dacarbazine/economics
  • Disease Progression
  • Disease-Free Survival
  • Female
  • Health Expenditures
  • Health Resources/economics
  • Humans
  • Imidazoles/economics
  • Ipilimumab/economics
  • Kaplan-Meier Estimate
  • Male
  • Markov Chains
  • Melanoma/drug therapy
  • Middle Aged
  • Models, Economic
  • Nivolumab/administration & dosage
  • Oximes/economics
  • Proto-Oncogene Proteins B-raf/genetics
  • Quality-Adjusted Life Years
  • Sex Factors
  • Skin Neoplasms/drug therapy
  • Vemurafenib/economics

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