Ipilimumab in 2nd line treatment of patients with advanced melanoma: a cost-effectiveness analysis.
Ipilimumab in 2nd line treatment of patients with advanced melanoma: a cost-effectiveness analysis.
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DOI：
10.3111/13696998.2012.739226
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发表时间：
2013-01-01
影响因子：
2.4
通讯作者：
Penrod, John R
中科院分区：
文献类型：
--
作者：
Barzey, Victor;Atkins, Michael B;Penrod, John R
目的：评估ipilimumab （3mg/kg）与最佳支持治疗（BSC）在预先治疗的晚期黑色素瘤患者中的成本效益。方法：分析是基于美国付款人的观点和一生的时间范围。建立了一个三状态马尔可夫模型，代表伊匹单抗和BSC治疗的患者的临床结果、生活质量和医疗资源使用。使用MDX010-20试验的总生存期和无进展生存期数据对状态之间的转换进行建模。效用数据来自一项针对普通人群健康状况偏好的黑色素瘤特异性研究。以2011年美元表示的疾病管理成本是基于美国回顾性医疗图表研究中观察到的医疗资源使用情况。不确定性分析采用单向和概率敏感性分析。结果：在整个生命周期内，引入伊匹单抗比BSC获得的生命年和QALYs分别为1.88年（95% CI=1.62-2.20）和1.14年（95% CI=1.01-1.34）。ipilimumab与BSC治疗的估计增量成本为146,716美元（95% CI= 130,992- 164,025美元）。估计每个生命年增加的增量成本效益比为78,218美元，每个质量质量年增加的增量成本效益比为128,656美元。Ipilimumab有95%的可能性具有成本效益，支付意愿为146,000美元/QALY。局限性：Ipilimumab的作用方法导致肿瘤反应模式不同于模型所依据的实体瘤反应评估标准，导致对Ipilimumab患者生活质量的潜在低估。生存和质量改善与分析的时间范围有关。敏感性分析表明，当质量调整方法和时间范围不同时，关于易普利姆单抗成本-效果的定性结论不变。结论：分析表明，ipilimumab的估计成本效益在美国肿瘤产品的付款人可以接受的范围内。
OBJECTIVE: To estimate the cost-effectiveness of ipilimumab (3mg/kg) compared with best supportive care (BSC) in pre-treated advanced melanoma patients.METHODS: The analysis was based on a US payer perspective and lifetime time horizon. A three-state Markov model was developed representing clinical outcomes, quality-of-life, and healthcare resource use of patients treated with ipilimumab and BSC. Transitions between states were modeled using overall and progression-free survival data from the MDX010-20 trial. Utility data were from a melanoma-specific study of the health state preferences of the general population. Disease management costs expressed in 2011 US Dollars were based on healthcare resource use observed in a US retrospective medical chart study. Uncertainty was analyzed using one-way and probabilistic sensitivity analyses.RESULTS: The gain in life years and QALYs from introducing ipilimumab over BSC were 1.88 years (95% CI=1.62-2.20) and 1.14 (95% CI=1.01-1.34) QALYs, respectively, over the lifetime time horizon. The estimated incremental cost of treating with ipilimumab vs BSC was $146,716 (95% CI=$130,992-$164,025). The estimated incremental cost-effectiveness ratios were $78,218 per life year gained and $128,656 per QALY gained. Ipilimumab was 95% likely to be cost-effective at a willingness-to-pay of $146,000/QALY.LIMITATIONS: Ipilimumab's method of action causes a tumor response pattern that differs from the Response Evaluation Criteria in Solid Tumors upon which the model is based, leading to a potential under-estimate of quality-of-life of ipilimumab patients. Survival and QALY gains were related to the time horizon of the analysis. Sensitivity analyses indicated that qualitative conclusions regarding the cost-effectiveness of ipilimumab were unchanged when the method of quality adjustment and the time horizon were varied.CONCLUSION: The analysis shows that the estimated cost-effectiveness of ipilimumab is within what has been shown to be acceptable to payers for oncology products in the US.