title: A Cost-Effectiveness Analysis of Nivolumab Compared with Ipilimumab for the Treatment of BRAF Wild-Type Advanced Melanoma in Australia.
abstract: OBJECTIVE
  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.
authors.affiliation: Melbourne EpiCentre, Royal Melbourne Hospital, and the University of Melbourne, Parkville, Victoria, Australia. Electronic address: megan.bohensky@unimelb.edu.au.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Bohensky
authors.affiliation: Melbourne EpiCentre, Royal Melbourne Hospital, and the University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Kumar
authors.initials: K
authors.lastname: Pasupathi
authors.affiliation: Melbourne EpiCentre, Royal Melbourne Hospital, and the University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gorelik
authors.affiliation: Bristol-Myers Squibb Australia, Mulgrave, Victoria, Australia.
authors.forename: Hansoo
authors.initials: H
authors.lastname: Kim
authors.affiliation: Bristol-Myers Squibb Australia, Mulgrave, Victoria, Australia.
authors.forename: James P
authors.initials: JP
authors.lastname: Harrison
authors.affiliation: Melbourne EpiCentre, Royal Melbourne Hospital, and the University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
mesh_terms: D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001315:Australia; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D000074324:Ipilimumab; D008390:Markov Chains; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D017059:Models, Econometric; D000077594:Nivolumab; D048493:Proto-Oncogene Proteins B-raf / Q000096:biosynthesis; D019057:Quality-Adjusted Life Years; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab; D000077594:Nivolumab; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
keywords: cost-effectiveness analysis; immunotherapy; melanoma; oncology