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    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 R
    Alkhatib, 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 Res
    Univ 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
    
    Metadata
    Show full item record
    Publisher
    AMER MEDICAL ASSOC
    Citation
    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.2018.3958
    Journal
    JAMA DERMATOLOGY
    Rights
    © 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 2018
    ISSN
    2168-6084
    PubMed ID
    30477000
    DOI
    10.1001/jamadermatol.2018.3958
    Version
    Final published version
    Additional Links
    https://jamanetwork.com/journals/jamadermatology/fullarticle/2715092
    ae974a485f413a2113503eed53cd6c53
    10.1001/jamadermatol.2018.3958
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