Pike E, et al. – This trial weighed the relative effectiveness and cost–effectiveness of seven new drugs (cobimetinib, dabrafenib, ipilimumab, nivolumab, pembrolizumab, trametinib and vemurafenib) for treating patients with advanced malignant melanoma in the Norwegian setting. Neither of the drugs appeared to be cost–effective at what was regarded as a reasonable willingness–to–pay (WTP) in Norway. Price reductions (from the official list prices) in the region of 63%–84% would be required for them to be cost–effective at a WTP of €55 850 per quality–adjusted life year (QALY).

Methods

• This multiple technology analysis comprised of patients with advanced malignant melanoma aged 18 or older.
• Data was collected from randomised controlled trials in relevant bibliographic databases.
• Meta-analyses were conduced using both direct and indirect evidence with dacarbazine as a common comparator.
• The therapies were ranked based on their likelihood of leading to the best results for each endpoint.
• The cost-utility analysis was based on a probabilistic discrete-time Markov cohort model.
• An estimation was performed of the costs and quality-adjusted life years (QALYs) with different treatment strategies from a healthcare perspective.
• Sensitivity analysis was carried out via Monte Carlo simulation.

Results

• A higher probability of good performance for overall survival than monotherapies with ipilimumab or BRAF/MEK inhibitors was determined by monotherapies with a programmed cell death 1 (PD-1) immune-checkpoint-inhibitor.
• Combination therapies illustrated similar levels of effectiveness to the PD-1 immune-checkpoint-inhibitors.
• PD-1 immune-checkpoint-inhibitors were more effective and more costly compared with ipilimumab in monotherapy.
• Nivolumab in combination with ipilimumab displayed higher costs and the same level of effectiveness as the PD-1 immune-checkpoint-inhibitors in monotherapy.
• Similar effectiveness and cost-effectiveness was noted in BRAF/MEK inhibitor combinations (dabrafenib and trametinib or vemurafenib and cobimetinib).
• Nevertheless, combination therapies exhibited a greater tendency of yielding higher quality adjusted life year gains than BRAF or MEK inhibitor monotherapies, but to a higher cost.