Economic Evaluation of Talimogene Laherparepvec Plus Ipilimumab Combination Therapy vs Ipilimumab Monotherapy in Patients With Advanced Unresectable Melanoma
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Author
Almutairi, Abdulaali RAlkhatib, Nimer S
Oh, Mok
Curiel-Lewandrowski, Clara
Babiker, Hani M
Cranmer, Lee D
McBride, Ali
Abraham, Ivo
Affiliation
Univ Arizona, Coll Pharm, Ctr Hlth Outcomes & PharmacoEcon ResUniv Arizona, Coll Pharm, Dept Pharm Practice & Sci
Univ Arizona, Coll Med, Dept Med, Div Dermatol
Univ Arizona, Arizona Canc Ctr
Univ Arizona, Coll Med, Dept Med, Div Hematol Oncol
Univ Arizona, Coll Med, Dept Family & Community Med
Issue Date
2019-01-01
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AMER MEDICAL ASSOCCitation
Almutairi AR, Alkhatib NS, Oh M, et al. Economic Evaluation of Talimogene Laherparepvec Plus Ipilimumab Combination Therapy vs Ipilimumab Monotherapy in Patients With Advanced Unresectable Melanoma. JAMA Dermatol. 2019;155(1):22–28. doi:10.1001/jamadermatol.2018.3958Journal
JAMA DERMATOLOGYRights
© 2018 American Medical Association. All rights reserved.Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.Abstract
IMPORTANCE. A phase 2 trial comparing talimogene laherparepvec plus ipilimumab vs ipilimumab monotherapy in patients with advanced unresectable melanoma found no differential benefit in progression-free survival (PFS) but noted objective response rates (ORRs) of 38.8% (38 of 98 patients) vs 18.0% (18 of 100 patients), respectively. OBJECTIVE To perform an economic evaluation of talimogene laherparepvec plus ipilimumab combination therapy vs ipilimumab monotherapy. DESIGN, SETTING, AND PARTICIPANTS For PFS, cost-effectiveness and cost-utility analyses using a 2-state Markov model (PFS vs progression or death) was performed. For ORRs, cost-effectiveness analysis of the incremental cost of 1 additional patient achieving objective response was performed. In this setting based on a US payer perspective (2017 US dollars), participants were patients with advanced unresectable melanoma. MAIN OUTCOMES AND MEASURES The PFS life-years and PF5 quality-adjusted life-years were determined, and the associated incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were estimated. Also estimated was the ICER per 1 additional patient (out of 100 treated patients) achieving objective response. Base-case analyses were validated by sensitivity analyses. RESULTS In PFS analyses, the cost of talimogene laherparepvec plus ipilimumab ($494 983) exceeded the cost of ipilimumab monotherapy ($132 950) by $362 033. The ICER was $2 129 606 per PFS life-years, and the ICUR was $2 262 706 per PFS quality-adjusted life-year gained. Probabilistic sensitivity analyses yielded an ICER of $1 481 208 per PFS life-year gained and an ICUR of $1 683 191 per PFS quality-adjusted life-year gained. In 1-way sensitivity analyses, the PFS hazard ratio and the utility of response were the most influential parameters. Talimogene laherparepvec plus ipilimumab has a 50% likelihood of being cost-effective at a willingness-to-pay threshold of $1 683 191 per PFS quality-adjusted life-year gained. In ORR analyses, talimogene laherparepvec plus ipilimumab ($474 904) vs ipilimumab alone ($132 810), a $342 094 difference, yielded an ICER of $1 629 019 per additional patient achieving objective response. In subgroup analyses by disease stage and BRAF(V600E) mutation status, ICERs ranged from $1 069 044 to $17 104 700 per 1 additional patient achieving objective response. CONCLUSIONS AND RELEVANCE The cost to gain 1 additional progression-free quality-adjusted life-year, 1 additional progression-free life-year, or to have 1 additional patient attain objective response is about $1.6 million. This amount may be beyond what payers typically are willing to pay. Combination therapy of talimogene laherparepvec plus ipilimumab does not offer an economically beneficial treatment option relative to ipilimumab monotherapy at the population level. This should not preclude treatment for individual patients for whom this regimen may be indicated.Note
12 month embargo; published online: 21 November 2018ISSN
2168-6084PubMed ID
30477000Version
Final published versionAdditional Links
https://jamanetwork.com/journals/jamadermatology/fullarticle/2715092ae974a485f413a2113503eed53cd6c53
10.1001/jamadermatol.2018.3958