Nivolumab is the most cost-effective treatment for advanced melanoma patients in England and represents good value for public money spent by the NHS, say the authors of a new study published in the European Journal of Health Economics.
The cost-effectiveness study used a Markov state-transition model to estimate the lifetime costs and benefits of nivolumab versus ipilimumab and dacarbazine for BRAF mutation-negative patients and versus ipilimumab, dabrafenib, and vemurafenib for BRAF mutation-positive patients.
For BRAF-negative patients, nivolumab was found to be the most effective (4.31 quality-adjusted life years [QALYs]) but also the most costly (£97,898 discounted lifetime costs) compared to dacarbazine (£25,228 and 1.23 QALYs) and ipilimumab (£57,158 and 2.64 QALYs). The incremental cost-effectiveness ratios (ICERs) for nivolumab vs ipilimumab and ipilimumab vs dacarbazine were estimated to be £24,483 and £22,589 per QALY gained, respectively.
The authors concluded that nivolumab should be considered the most cost-effective treatment for BRAF-negative patients in England if the willingness-to-pay (WTP) threshold is above £24,483; ipilimumab should be considered most cost-effective if the WTP threshold is between £22,589 and £24,482; and dacarbazine should be considered most cost-effective if the threshold is below £22,589. The estimated ICER for nivolumab are below the NICE willingness-to-pay (WTP) threshold of £50,000 for end-of-life treatments.
For BRAF-positive patients, nivolumab was also most effective (4.27 QALYs) but most costly (£88,228) compared to ipilimumab (£56,621 and 2.44 QALYs), dabrafenib (£71,511 and 1.69 QALYs) and vemurafenib (£74,001 and 2.37 QALYs). The ICER for nivolumab vs ipilimumab (the only non-dominated comparator) was estimated to be £17,362, making nivolumab the most cost-effective treatment for BRAF-positive patients.
Probabilistic sensitivity analysis (PSA) estimated that the probability of nivolumab being most cost-effective compared to the comparators was 95 per cent for BRAF-negative patients and 99 per cent BRAF-positive patients, respectively.
