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Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France

Nine drugs have been marketed for 10 years for the treatment of advanced melanoma (AM). With half of patients reaching a second line, the optimal sequence of treatments remains unclear. To inform policy-makers about their efficiency, we performed a cost-effectiveness analysis of sequential strategie...

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Autores principales: Kandel, Marguerite, Bardet, Aurélie, Dalle, Stéphane, Allayous, Clara, Mortier, Laurent, Guillot, Bernard, Dutriaux, Caroline, Leccia, Marie-Thérèse, Dalac, Sophie, Montaudie, Henri, Saiag, Philippe, Legoupil, Delphine, Brunet-Possenti, Florence, Arnault, Jean-Philippe, Quatrebarbes, Julie De, Beylot-Barry, Marie, Maubec, Eve, Lesimple, Thierry, Aubin, François, Grob, Jean-Jacques, Granel-Brocard, Florence, Stoebner, Pierre-Emmanuel, Dupuy, Alain, Dreno, Brigitte, Michiels, Stefan, Lebbe, Céleste, Borget, Isabelle
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777106/
https://www.ncbi.nlm.nih.gov/pubmed/36547139
http://dx.doi.org/10.3390/curroncol29120725
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author Kandel, Marguerite
Bardet, Aurélie
Dalle, Stéphane
Allayous, Clara
Mortier, Laurent
Guillot, Bernard
Dutriaux, Caroline
Leccia, Marie-Thérèse
Dalac, Sophie
Montaudie, Henri
Saiag, Philippe
Legoupil, Delphine
Brunet-Possenti, Florence
Arnault, Jean-Philippe
Quatrebarbes, Julie De
Beylot-Barry, Marie
Maubec, Eve
Lesimple, Thierry
Aubin, François
Grob, Jean-Jacques
Granel-Brocard, Florence
Stoebner, Pierre-Emmanuel
Dupuy, Alain
Dreno, Brigitte
Michiels, Stefan
Lebbe, Céleste
Borget, Isabelle
author_facet Kandel, Marguerite
Bardet, Aurélie
Dalle, Stéphane
Allayous, Clara
Mortier, Laurent
Guillot, Bernard
Dutriaux, Caroline
Leccia, Marie-Thérèse
Dalac, Sophie
Montaudie, Henri
Saiag, Philippe
Legoupil, Delphine
Brunet-Possenti, Florence
Arnault, Jean-Philippe
Quatrebarbes, Julie De
Beylot-Barry, Marie
Maubec, Eve
Lesimple, Thierry
Aubin, François
Grob, Jean-Jacques
Granel-Brocard, Florence
Stoebner, Pierre-Emmanuel
Dupuy, Alain
Dreno, Brigitte
Michiels, Stefan
Lebbe, Céleste
Borget, Isabelle
author_sort Kandel, Marguerite
collection PubMed
description Nine drugs have been marketed for 10 years for the treatment of advanced melanoma (AM). With half of patients reaching a second line, the optimal sequence of treatments remains unclear. To inform policy-makers about their efficiency, we performed a cost-effectiveness analysis of sequential strategies in clinical practice in France, for BRAF-mutated and wild-type patients. A multistate model was developed to describe treatment sequences, associated costs, and health outcomes over 10 years. Sequences, clinical outcomes, utility scores, and economic data were extracted from the prospective Melbase cohort, collecting individual data in 1518 patients since 2013, from their AM diagnosis until their death. To adjust the differences in patients’ characteristics among sequences, weighting by inverse probability was used. In the BRAF-mutated population, the MONO-targeted therapies (TT)-anti-PD1 sequence was the less expensive, whereas the anti-PD1-BI-TT sequence had an incremental cost-effectiveness ratio (ICER) of 180,441 EUR/QALY. Regarding the BRAF wild-type population, the three sequences constituted the cost-effective frontier, with ICERs ranging from 116 to 806,000 EUR/QALY. For BRAF-mutated patients, the sequence anti-PD1-BI-TT appeared to be the most efficient one in BRAF-mutated AM patients until 2018. Regarding the BRAF wild-type population until 2018, the sequence starting with IPI+NIVO appeared inefficient compared to anti-PD1, considering the extra cost for the QALY gained.
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spelling pubmed-97771062022-12-23 Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France Kandel, Marguerite Bardet, Aurélie Dalle, Stéphane Allayous, Clara Mortier, Laurent Guillot, Bernard Dutriaux, Caroline Leccia, Marie-Thérèse Dalac, Sophie Montaudie, Henri Saiag, Philippe Legoupil, Delphine Brunet-Possenti, Florence Arnault, Jean-Philippe Quatrebarbes, Julie De Beylot-Barry, Marie Maubec, Eve Lesimple, Thierry Aubin, François Grob, Jean-Jacques Granel-Brocard, Florence Stoebner, Pierre-Emmanuel Dupuy, Alain Dreno, Brigitte Michiels, Stefan Lebbe, Céleste Borget, Isabelle Curr Oncol Article Nine drugs have been marketed for 10 years for the treatment of advanced melanoma (AM). With half of patients reaching a second line, the optimal sequence of treatments remains unclear. To inform policy-makers about their efficiency, we performed a cost-effectiveness analysis of sequential strategies in clinical practice in France, for BRAF-mutated and wild-type patients. A multistate model was developed to describe treatment sequences, associated costs, and health outcomes over 10 years. Sequences, clinical outcomes, utility scores, and economic data were extracted from the prospective Melbase cohort, collecting individual data in 1518 patients since 2013, from their AM diagnosis until their death. To adjust the differences in patients’ characteristics among sequences, weighting by inverse probability was used. In the BRAF-mutated population, the MONO-targeted therapies (TT)-anti-PD1 sequence was the less expensive, whereas the anti-PD1-BI-TT sequence had an incremental cost-effectiveness ratio (ICER) of 180,441 EUR/QALY. Regarding the BRAF wild-type population, the three sequences constituted the cost-effective frontier, with ICERs ranging from 116 to 806,000 EUR/QALY. For BRAF-mutated patients, the sequence anti-PD1-BI-TT appeared to be the most efficient one in BRAF-mutated AM patients until 2018. Regarding the BRAF wild-type population until 2018, the sequence starting with IPI+NIVO appeared inefficient compared to anti-PD1, considering the extra cost for the QALY gained. MDPI 2022-11-27 /pmc/articles/PMC9777106/ /pubmed/36547139 http://dx.doi.org/10.3390/curroncol29120725 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kandel, Marguerite
Bardet, Aurélie
Dalle, Stéphane
Allayous, Clara
Mortier, Laurent
Guillot, Bernard
Dutriaux, Caroline
Leccia, Marie-Thérèse
Dalac, Sophie
Montaudie, Henri
Saiag, Philippe
Legoupil, Delphine
Brunet-Possenti, Florence
Arnault, Jean-Philippe
Quatrebarbes, Julie De
Beylot-Barry, Marie
Maubec, Eve
Lesimple, Thierry
Aubin, François
Grob, Jean-Jacques
Granel-Brocard, Florence
Stoebner, Pierre-Emmanuel
Dupuy, Alain
Dreno, Brigitte
Michiels, Stefan
Lebbe, Céleste
Borget, Isabelle
Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France
title Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France
title_full Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France
title_fullStr Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France
title_full_unstemmed Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France
title_short Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France
title_sort cost-effectiveness analysis of sequential treatment strategies for advanced melanoma in real life in france
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777106/
https://www.ncbi.nlm.nih.gov/pubmed/36547139
http://dx.doi.org/10.3390/curroncol29120725
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