A Cost-Effectiveness Analysis of Nivolumab Compared with Ipilimumab for the Treatment of BRAF Wild-Type Advanced Melanoma in Australia
A Cost-Effectiveness Analysis of Nivolumab Compared with Ipilimumab for the Treatment of BRAF Wild-Type Advanced Melanoma in Australia
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DOI：
10.1016/j.jval.2016.05.013
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发表时间：
2016-12-01
期刊：
影响因子：
4.5
通讯作者：
Liew, Danny
中科院分区：
文献类型：
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作者：
Bohensky, Megan A.;Pasupathi, Kumar;Liew, Danny
目的：本研究的目的是从澳大利亚卫生系统的角度评估nivolumab与ipilimumab治疗既往未经治疗的BRAF晚期黑色素瘤（BRAF-AM）患者的成本效益。方法：建立状态转移马尔可夫模型来模拟澳大利亚BRAF-AM患者的进展。该模型有一个10年的时间范围，结果每年贴现5%。对于nivolumab组，进展和死亡的风险基于在III期试验的nivolumab组中观察到的风险（nivolumab vs.达卡巴嗪）。无进展生存期和总生存期使用对数逻辑分布的参数生存模型进行外推。在缺乏头对头证据的情况下，使用已发表的数据，基于间接比较估计易普利姆玛的总生存期和无进展生存期。管理AM的成本是根据对澳大利亚临床医生的调查估计的。ipilimumab的费用基于澳大利亚的报销价格。纳武利尤单抗的成本基于澳大利亚的预期报销价格。在试验中使用EuroQol五维问卷获得生活质量数据。结果如下：与ipilimumab相比，nivolumab治疗10年估计每人可获得1.58生命年和1.30质量调整生命年，（折扣）净成本为每人39，039美元。与ipilimumab相比，nivolumab的增量成本效益比为每年挽救生命25,101美元，每挽救质量调整生命年30,475美元。结论：在澳大利亚，与ipilimumab相比，Nivolumab是预防AM患者下游死亡率和发病率的一种具有成本效益的方法。
Purpose: The aim of this study was to evaluate the cost-effectiveness of nivolumab versus ipilimumab for the treatment of previously untreated patients with BRAF-advanced melanoma (BRAF-AM) from an Australian health system perspective. Methods: A state-transition Markov model was constructed to simulate the progress of Australian patients with BRAF-AM. The model had a 10-year time horizon with outcomes discounted at 5% annually. For the nivolumab group, risks of progression and death were based on those observed in the nivolumab arm of a phase III trial (nivolumab vs. dacarbazine). Progression-free survival and overall survival were extrapolated using parametric survival modeling with a log-logistic distribution. In the absence of head-to-head evidence, overall survival and progression free survival for ipilimumab were estimated on the basis of an indirect comparison using published data. Costs of managing AM were estimated from a survey of Australian clinicians. The cost of ipilimumab was based on the reimbursement price in Australia. The cost of nivolumab was based on expected reimbursement prices in Australia. Quality-of-life data were obtained within the trial using the EuroQol five-dimensional questionnaire. Results: Compared with ipilimumab, nivolumab therapy over 10 years was estimated to yield 1.58 life-years and 1.30 quality-adjusted life-years per person, at a (discounted) net cost of US $39,039 per person. The incremental cost-effectiveness ratios for nivolumab compared with ipilimumab were US $25,101 per year of life saved and $30,475 per quality-adjusted life-year saved. Conclusions: Nivolumab is a cost-effective means of preventing downstream mortality and morbidity in patients with AM compared with ipilimumab in the Australian setting.