First-line Immune Checkpoint Inhibition Cost-effective in Melanoma

First-line immune checkpoint inhibition is more cost-effective than chemotherapy for treatment-naïve, BRAF wild-type, stage IV melanoma, according to a modeling study published in the Journal of Clinical Oncology.¹

Immune checkpoint inhibitors have improved clinical outcomes for patients with advanced melanoma, but are associated with high costs and adverse events. The purpose of this study was to determine the cost-effectiveness of the available treatments to inform health care providers, policy makers, and patients.

The study used a Markov model with a US-payer perspective and lifetime horizon to estimate costs in 2016 US-dollars and quality-adjusted life-years (QALYs). Regimens were compared using incremental cost-effectiveness ratios (ICERs).

The model evaluated the cost-effectiveness of the following treatment regimens: nivolumab followed by ipilimumab, nivolumab plus ipilimumab followed by carboplatin plus paclitaxel, pembrolizumab every 2 weeks followed by ipilimumab, pembrolizumab every 3 weeks followed by ipilimumab, ipilimumab followed by nivolumab, and dacarbazine followed by ipilimumab then nivolumab.

First-line pembrolizumab every 3 weeks followed by ipilimumab was the most cost-effective regimen with a total cost of $127,626 compared with first-line dacarbazine ($146,775), ipilimumab ($152,403), pembrolizumab every 2 weeks ($164,871), nivolumab ($172,219), or nivolumab plus ipilimumab ($206,435) in a base-case analysis.

The analysis included pairwise comparisons among the study arms. Compared with first-line dacarbazine followed by ipilimumab then nivolumab, the only dominant (clinically superior and cost-saving) regimen was pembrolizumab every 3 weeks followed by ipilimumab.

According to the authors, “The current cost-effectiveness analysis should be included in the decision-making process with additional efficacy data (and individual patient data) to make recommendations regarding the sequencing of therapy for patients with BRAF wild-type advanced melanoma.”

Reference

1. Kohn CG, Zeichner SB, Chen Q, Montero AJ, Goldstein DA, Flowers CF. Cost-effectiveness of immune checkpoint inhibition in BRAF wild-type advanced melanoma. J Clin Oncol. 21 Feb 2017 doi: 10.1200/JCO.2016.69.6336 [Epub ahead of print]