Clinical and Economic Outcomes Associated with Treatment Sequences In Patients With BRAF -Mutant Advanced Melanoma

作者：Ahmad A. Tarhini, David F. McDermott, Apoorva Ambavane, Komal Gupte-Singh, Valerie Aponte Ribero, Corey Ritchings, Ágnes Benedict, Sumati Rao, Meredith M. Regan, Michael B. Atkins · 发表于：Immunotherapy · 年份：2018 · DOI：10.2217/imt-2018-0168 · 被引用次数：35 · 研究领域：Melanoma and MAPK Pathways、Cutaneous Melanoma Detection and Management、Cancer Immunotherapy and Biomarkers

AIM: The cost-effectiveness of treatment sequences in BRAF-mutant advanced melanoma. MATERIALS & METHODS: A discrete event simulation model was developed to estimate total costs and health outcomes over a patient's lifetime (30 years). Efficacy was based on the CheckMate 067/069 trials and a matching-adjusted-indirect comparison between immuno-oncology and targeted therapies. Safety, cost (in US dollars; US third-party payer perspective) and health-related quality-of-life inputs were based on published literature. RESULTS: Estimated survival gain was higher for sequences initiating with anti-PD-1 + anti-CTLA-4 than for anti-PD-1 monotherapy or BRAF+MEK inhibitors. The incremental cost-effectiveness ratio per QALY gained for first-line anti-PD-1 + anti-CTLA-4 was US$54,273 versus first-line anti-PD-1 and $79,124 versus first-line BRAF+MEK inhibitors. CONCLUSION: Initiating treatment with anti-PD-1 + anti-CTLA-4 was more cost-effective than initiation with anti-PD-1 monotherapy or BRAF+MEK inhibitors.