Ipilimumab in 2nd line treatment of patients with advanced melanoma: a cost-effectiveness analysis

Abstract

Objective:

To estimate the cost-effectiveness of ipilimumab (3 mg/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 vs 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 under-estimate 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.

Keywords::

• Cost effectiveness
• Ipilimumab
• Markov
• Melanoma

Transparency

Declaration of funding

This study was funded by Bristol Myers Squibb, Wallingford, CT.

Declaration of financial/other relationships

Srividya Kotapati and John R Penrod have disclosed that they were employees of Bristol Myers Squibb. Srividya Kotapati and John R Penrod own shares in Bristol Myers Squibb. Yumi Asukai and Victor Barzey have disclosed they were employees of IMS Health, a company that was paid consultancy fees by the sponsor of this study. Michael Atkins was a Professor at Georgetown University Medical School and a Deputy Director of the Georgetown-Lombardi Comprehensive Cancer Center. Dr Atkins received an honorarium payment for his support. Louis Garrison was a Professor at the School of Pharmacy, an Adjunct Professor in Global Health, and an Adjunct Professor in Health Services within the Pharmaceutical Outcomes Research & Policy Program at the University of Washington School of Pharmacy. Professor Garrison also received an honorarium payment for his support.

Author contributions

Victor Barzey and Yumi Asukai built the model. Srividya Kotapati and John Penrod provided data inputs and conceptual support. Dr Atkins provided validation of the clinical assumptions. Professor Garrison provided validation of the economic assumptions. All authors contributed to the drafting and reviewing of the manuscript.

Acknowledgment

The authors would like to acknowledge the work of Sonja Sorensen, MPH, and Feng Pan, PhD, from United BioSource Corporation for their initial contribution to the development of the cost-effectiveness model.

Notice of Correction

The version of this article published online ahead of print on 31 October 2012 contained an error on page 1. The sentence “Ipilimumab was 95% likely to be cost-effective at a willingness-to-pay of £146,000/QALY.” should have read “Ipilimumab was 95% likely to be cost-effective at a willingness-to-pay of $146,000/QALY.” The error has been corrected for this version.