Ipilimumab in 2nd line treatment of patients with advanced melanoma: a cost-effectiveness analysis.
OBJECTIVE
To estimate the cost-effectiveness of ipilimumab (3 mg/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.


CONCLUSIONS
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.


CONCLUSIONS
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.
IMS Health Economics and Outcomes Research, 210 Pentonville Road, London, UK. vbarzey@uk.imshealth.com
Victor
V
Barzey
Michael B
MB
Atkins
Louis P
LP
Garrison
Yumi
Y
Asukai
Srividya
S
Kotapati
John R
JR
Penrod
D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis / Q000191:economics; D018572:Disease-Free Survival; D006801:Humans; D000074324:Ipilimumab; D008390:Markov Chains; D008485:Medical Audit; D008545:Melanoma / Q000188:drug therapy* / Q000473:pathology*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab