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

Figures & data

Figure 1.  Overall and progression-free survival curves for ipilimumab and gp100 from MDX010-020.

Figure 2.  Comparison of the estimated log-normal parametric overall survival curves to the observed overall survival curves from MDX010-020.

Table 1.  Clinical, cost, and utility inputs used the cost-effectiveness model base case.

Parameter	Value	Sensitivity analysis range		Distribution
		Lower bound	Upper bound
Discount rate costs	0.03
Discount rate benefits	0.03
Drug costs
Ipilimumab cost per cycle	$30,000
Iplimumab administration	$504
Weekly cost for 3rd line treatment	$89	$71	$107	Gamma
On treatment disease management costs
ipilimumab	$822	$658	$987	Gamma
BSC	$1518	$1214	$1822	Gamma
Off treatment disease management costs
ipilimumab	$1518	$1214	$1822	Gamma
BSC	$1518	$1214	$1822	Gamma
Estimated average treatment costs per toxicity
Fever	$3304	$2115	$4758	Mixed*
Infection	$4331	$2772	$6237	Mixed*
Myalgia/Pain	$1947	$1246	$2734	Mixed*
Fatigue	$2069	$1324	$2977	Mixed*
Diarrhea	$775	$496	$1097	Mixed*
Nausea/Vomiting	$1442	$923	$1904	Mixed*
Colitis	$8563	$5480	$12331	Mixed*
Dyspnea	$3345	$2141	$4816	Mixed*
Anemia	$851	$544	$1112	Mixed*
Thrombocytopenia	$854	$547	$1193	Mixed*
Neutropenia	$859	$550	$1200	Mixed*
Oliguria	$3807	$2437	$4569	Mixed*
Anuria	$3807	$2437	$4569	Mixed*
Hypopituitarism	$4979	$3186	$7170	Mixed*
Glomerulonephritis	$4218	$2699	$6073	Mixed*
Reinduction
Proportion receiving re-induction	0.07	0.05	0.07	Beta
Average # doses	5.44	4.352	5.76	Gamma
Response rate
Ipilimumab	0.11	0.088	0.132	Beta
BSC	0
Health state utilities
Complete/partial response	0.88	0.70	1.00	Beta
Stable disease	0.80	0.64	0.96	Beta
Progressive disease	0.52	0.42	0.62	Beta
Death	0
Toxicity utility decrements
Inpatient treatment	−0.17			Beta
Outpatient treatment	−0.13			Beta

*Derived values. Beta and gamma distributions were used for component parts.

Table 2.  Results of the cost-effectiveness analysis.

	Point estimate	95% CI
		Lower bound	Upper bound
Ipilimumab
Cost	$168,602	$154,354	$185,622
LY	2.88	2.63	3.19
QALY	1.76	1.62	1.96
BSC
Cost	$21,886	$17,359	$27,439
LY	1.0	0.98	1.03
QALY	0.62	0.59	0.65
Incremental
Cost	$146,716	$130,992	$164,025
LY	1.88	1.62	2.20
QALY	1.14	1.01	1.34
ICER*	$78,218/LY gained	NA	NA
ICUR*	$128,656/QALY gained	NA	NA

*Uncertainty in the cost-effectiveness ratios is examined through Probabilistic Sensitivity Analysis and CE acceptability analyses described below and shown in Figures 3 and 4.

Table 3.  Disaggregated costs of treating advanced melanoma patients over the lifetime time horizon.

	Ipilimumab	BSC	Incremental
Active Treatment (drug only)	$114,735	$0	$114,735
Active Admin	$1928	$0	$1928
Subsequent active treatment	$18	$18	−$1
Follow-up on treatment	$1964	$2840	−$876
Follow-up at time of progression	$4797	$4991	−$193
Follow-up off treatment (pre-progression)	$6649	$2187	$4462
Follow-up off treatment	$37,708	$11,851	$25,857
Toxicity management	$803	$0	$803

Figure 3.  Scatter plot of the 1000 sampled incremental cost and QALY estimates from the probabilistic sensitivity analysis.

Figure 4.  The cost effectiveness acceptability curve for the economic evaluation comparing ipilimumab and GP100.

Figure 5.  Tornado diagram showing the results of the one way sensitivity and scenario analysis.