TY - JOUR
T1 - Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France
AU - Kandel, Marguerite
AU - Bardet, Aurélie
AU - Dalle, Stéphane
AU - Allayous, Clara
AU - Mortier, Laurent
AU - Guillot, Bernard
AU - Dutriaux, Caroline
AU - Leccia, Marie Thérèse
AU - Dalac, Sophie
AU - Montaudie, Henri
AU - Saiag, Philippe
AU - Legoupil, Delphine
AU - Brunet-Possenti, Florence
AU - Arnault, Jean Philippe
AU - Quatrebarbes, Julie De
AU - Beylot-Barry, Marie
AU - Maubec, Eve
AU - Lesimple, Thierry
AU - Aubin, François
AU - Grob, Jean Jacques
AU - Granel-Brocard, Florence
AU - Stoebner, Pierre Emmanuel
AU - Dupuy, Alain
AU - Dreno, Brigitte
AU - Michiels, Stefan
AU - Lebbe, Céleste
AU - Borget, Isabelle
N1 - Publisher Copyright:
© 2022 by the authors.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Nine drugs have been marketed for 10 years for the treatment of advanced melanoma (AM). With half of patients reaching a second line, the optimal sequence of treatments remains unclear. To inform policy-makers about their efficiency, we performed a cost-effectiveness analysis of sequential strategies in clinical practice in France, for BRAF-mutated and wild-type patients. A multistate model was developed to describe treatment sequences, associated costs, and health outcomes over 10 years. Sequences, clinical outcomes, utility scores, and economic data were extracted from the prospective Melbase cohort, collecting individual data in 1518 patients since 2013, from their AM diagnosis until their death. To adjust the differences in patients’ characteristics among sequences, weighting by inverse probability was used. In the BRAF-mutated population, the MONO-targeted therapies (TT)-anti-PD1 sequence was the less expensive, whereas the anti-PD1-BI-TT sequence had an incremental cost-effectiveness ratio (ICER) of 180,441 EUR/QALY. Regarding the BRAF wild-type population, the three sequences constituted the cost-effective frontier, with ICERs ranging from 116 to 806,000 EUR/QALY. For BRAF-mutated patients, the sequence anti-PD1-BI-TT appeared to be the most efficient one in BRAF-mutated AM patients until 2018. Regarding the BRAF wild-type population until 2018, the sequence starting with IPI+NIVO appeared inefficient compared to anti-PD1, considering the extra cost for the QALY gained.
AB - Nine drugs have been marketed for 10 years for the treatment of advanced melanoma (AM). With half of patients reaching a second line, the optimal sequence of treatments remains unclear. To inform policy-makers about their efficiency, we performed a cost-effectiveness analysis of sequential strategies in clinical practice in France, for BRAF-mutated and wild-type patients. A multistate model was developed to describe treatment sequences, associated costs, and health outcomes over 10 years. Sequences, clinical outcomes, utility scores, and economic data were extracted from the prospective Melbase cohort, collecting individual data in 1518 patients since 2013, from their AM diagnosis until their death. To adjust the differences in patients’ characteristics among sequences, weighting by inverse probability was used. In the BRAF-mutated population, the MONO-targeted therapies (TT)-anti-PD1 sequence was the less expensive, whereas the anti-PD1-BI-TT sequence had an incremental cost-effectiveness ratio (ICER) of 180,441 EUR/QALY. Regarding the BRAF wild-type population, the three sequences constituted the cost-effective frontier, with ICERs ranging from 116 to 806,000 EUR/QALY. For BRAF-mutated patients, the sequence anti-PD1-BI-TT appeared to be the most efficient one in BRAF-mutated AM patients until 2018. Regarding the BRAF wild-type population until 2018, the sequence starting with IPI+NIVO appeared inefficient compared to anti-PD1, considering the extra cost for the QALY gained.
KW - advanced melanoma
KW - cost-effectiveness analysis
KW - immunotherapy
KW - real-life clinical practice
KW - targeted therapy
UR - http://www.scopus.com/inward/record.url?scp=85144512210&partnerID=8YFLogxK
U2 - 10.3390/curroncol29120725
DO - 10.3390/curroncol29120725
M3 - Article
C2 - 36547139
AN - SCOPUS:85144512210
SN - 1718-7729
VL - 29
SP - 9255
EP - 9270
JO - Current Oncology
JF - Current Oncology
IS - 12
ER -