Yang Meng1, Nadine Hertel2, John Ellis2, Edith Morais2, Helen Johnson3, Zoe Philips4, Neil Roskell4, Andrew Walker5, Dawn Lee4. 1. BresMed Health Solutions, North Church House, 84 Queen Street, Sheffield, S1 2DW, UK. ymeng@bresmed.com. 2. Bristol-Myers Squibb Pharmaceuticals, Uxbridge, UK. 3. Helen Johnson Consulting Ltd, Welwyn Garden City, UK. 4. BresMed Health Solutions, North Church House, 84 Queen Street, Sheffield, S1 2DW, UK. 5. University of Glasgow, Glasgow, UK.
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.
RCT Entities:
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 melanomapatients. OBJECTIVE: To evaluate the cost effectiveness of nivolumab monotherapy for the treatment of advanced melanomapatients 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 melanomapatients in England.
Authors: Paul B Chapman; Axel Hauschild; Caroline Robert; John B Haanen; Paolo Ascierto; James Larkin; Reinhard Dummer; Claus Garbe; Alessandro Testori; Michele Maio; David Hogg; Paul Lorigan; Celeste Lebbe; Thomas Jouary; Dirk Schadendorf; Antoni Ribas; Steven J O'Day; Jeffrey A Sosman; John M Kirkwood; Alexander M M Eggermont; Brigitte Dreno; Keith Nolop; Jiang Li; Betty Nelson; Jeannie Hou; Richard J Lee; Keith T Flaherty; Grant A McArthur Journal: N Engl J Med Date: 2011-06-05 Impact factor: 91.245
Authors: Wilbert B van den Hout; Gijsbert W P M Kramer; Ed M Noordijk; Jan-Willem H Leer Journal: J Natl Cancer Inst Date: 2006-12-20 Impact factor: 13.506
Authors: F Stephen Hodi; Steven J O'Day; David F McDermott; Robert W Weber; Jeffrey A Sosman; John B Haanen; Rene Gonzalez; Caroline Robert; Dirk Schadendorf; Jessica C Hassel; Wallace Akerley; Alfons J M van den Eertwegh; Jose Lutzky; Paul Lorigan; Julia M Vaubel; Gerald P Linette; David Hogg; Christian H Ottensmeier; Celeste Lebbé; Christian Peschel; Ian Quirt; Joseph I Clark; Jedd D Wolchok; Jeffrey S Weber; Jason Tian; Michael J Yellin; Geoffrey M Nichol; Axel Hoos; Walter J Urba Journal: N Engl J Med Date: 2010-06-05 Impact factor: 91.245
Authors: Jeffrey A Sosman; Kevin B Kim; Lynn Schuchter; Rene Gonzalez; Anna C Pavlick; Jeffrey S Weber; Grant A McArthur; Thomas E Hutson; Stergios J Moschos; Keith T Flaherty; Peter Hersey; Richard Kefford; Donald Lawrence; Igor Puzanov; Karl D Lewis; Ravi K Amaravadi; Bartosz Chmielowski; H Jeffrey Lawrence; Yu Shyr; Fei Ye; Jiang Li; Keith B Nolop; Richard J Lee; Andrew K Joe; Antoni Ribas Journal: N Engl J Med Date: 2012-02-23 Impact factor: 91.245
Authors: Claus Garbe; Ketty Peris; Axel Hauschild; Philippe Saiag; Mark Middleton; Alan Spatz; Jean-Jacques Grob; Josep Malvehy; Julia Newton-Bishop; Alexander Stratigos; Hubert Pehamberger; Alexander M Eggermont Journal: Eur J Cancer Date: 2012-09-13 Impact factor: 9.162
Authors: Howard L Kaufman; John M Kirkwood; F Stephen Hodi; Sanjiv Agarwala; Thomas Amatruda; Steven D Bines; Joseph I Clark; Brendan Curti; Marc S Ernstoff; Thomas Gajewski; Rene Gonzalez; Laura Jane Hyde; David Lawson; Michael Lotze; Jose Lutzky; Kim Margolin; David F McDermott; Donald Morton; Anna Pavlick; Jon M Richards; William Sharfman; Vernon K Sondak; Jeffrey Sosman; Susan Steel; Ahmad Tarhini; John A Thompson; Jill Titze; Walter Urba; Richard White; Michael B Atkins Journal: Nat Rev Clin Oncol Date: 2013-08-27 Impact factor: 66.675
Authors: K M Beusterien; S M Szabo; S Kotapati; J Mukherjee; A Hoos; P Hersey; M R Middleton; A R Levy Journal: Br J Cancer Date: 2009-07-14 Impact factor: 7.640
Authors: Anthony J Hatswell; Becky Pennington; Louisa Pericleous; Donna Rowen; Maximilian Lebmeier; Dawn Lee Journal: Health Qual Life Outcomes Date: 2014-09-10 Impact factor: 3.186
Authors: Vivek Verma; Tanja Sprave; Waqar Haque; Charles B Simone; Joe Y Chang; James W Welsh; Charles R Thomas Journal: J Immunother Cancer Date: 2018-11-23 Impact factor: 13.751
Authors: Anh Dam Tran; Angela M Hong; Mai T H Nguyen; Gerald Fogarty; Victoria Steel; Elizabeth Paton; Rachael L Morton Journal: Pharmacoecon Open Date: 2022-05-05
Authors: Johannes Schwenck; Barbara Schörg; Francesco Fiz; Dominik Sonanini; Andrea Forschner; Thomas Eigentler; Benjamin Weide; Manuela Martella; Irene Gonzalez-Menendez; Cristina Campi; Gianmario Sambuceti; Ferdinand Seith; Leticia Quintanilla-Martinez; Claus Garbe; Christina Pfannenberg; Martin Röcken; Christian la Fougere; Bernd J Pichler; Manfred Kneilling Journal: Theranostics Date: 2020-01-01 Impact factor: 11.556