Document Detail


Ipilimumab in 2(nd) line treatment of patients with advanced melanoma: a cost-effectiveness analysis.
MedLine Citation:
PMID:  23057750     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Objective: To estimate the cost effectiveness of ipilimumab (3mg/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 versus 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. Limitations: 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 underestimate 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. Conclusion: 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.
Authors:
Victor Barzey; Michael B Atkins; Louis P Garrison; Yumi Asukai; Srividya Kotapati; John R Penrod
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-11
Journal Detail:
Title:  Journal of medical economics     Volume:  -     ISSN:  1941-837X     ISO Abbreviation:  J Med Econ     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9892255     Medline TA:  J Med Econ     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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