Table 2 Overview of the included cost–utility analyses
From: Effectiveness and cost-effectiveness of combination therapy versus monotherapy in malignant melanoma
Authors, year, country | Intervention | Comparator | Model | Perspective, cost type, time horizon | Discount rate per year [%] | Costs | QALY | ICER | Max. WTP | Sponsor | Conclusion |
|---|---|---|---|---|---|---|---|---|---|---|---|
BRAF-inhibitor plus MEK-inhibitor versus PD-1-inhibitor or BRAF-inhibitor | |||||||||||
Bensimon et al., 2020, US | [1] DABmax12 (150 mg 2 × daily) + TRAMmax12 (2 mg 1 × daily) | [2] PEMmax12 (200 mg every 3 weeks) | Markov model with four states (recurrence-free, loco-regional recurrence, distant metastases, and death) | Payer, direct costs, lifelong | Costs: 3 Effectiveness: 3 | Base case: [1] 583.588 USD [2] 520.812 USD | Base case: [1] 8.15 [2] 9.07 | [2] is dominant | 100.000 USD | Merck Sharp & Dohme | PEM is dominant over DAB plus TRAM with lower costs and higher QALYs |
Matter-Walstra et al., 2015, Switzerland | [1] DAB (150 mg 2 × daily) + TRAM (2 mg 1 × daily) | [2] VEM (960 mg 2 × daily) | Markov model with three health states (progression-free, disease progression, and death) | Payer, direct costs, lifelong | Costs: 3 and 6 Effectiveness: 3 and 6 | Base case: [1]: 311.421 CHF [2]: 111.773 CHF 3% discount rate: [1]: 302.747 CHF [2]: 110.187 CHF 6% discount rate: [1]: 294.984 CHF [2]: 108.730 CHF | Base case: [1]: 1.54 [2]: 1.02 3% discount rate: [1]: 1.49 [2]: 1.0 6% discount rate: [1]: 1.45 [2]: 0.99 | Base case: 385.603 CHF/QALY 3% discount rate: 395.204 CHF/QALY 6% discount rate: 404.542 CHF/QALY | 100.000 CHF | State secretariat for Education, Research, and Innovation | At the maximum WTP of CHF 100,000/QALY, DAB plus TRAM is not cost-effective compared to VEM in Switzerland |
PD-1-inhibitor plus CTLA-4-inhibitor versus CTLA-4-inhibitor or PD-1-inhibitor | |||||||||||
Paly et al., 2020, Japan | [1] NIVO (1 mg/kg) + IPI (3 mg/kg) once every 3 weeks for 4 doses, then NIVO (3 mg/kg) only every 2 weeks | [2] NIVO (240 mg every 2 weeks) [3] IPI (3 mg/kg every 3 weeks for a total of 4 doses) | Partitioned three-state survival model (pre-progression, post-progression, and death) | Payer, direct costs, 30 years | Costs: 2 Effectiveness: 2 | Base case: [1] 180.649,54 USD [2] 169.958,06 USD [3] 109.314,61 USD | Base case l: [1] 7.7 [2] 6.2 [3] 2.8 | [1] vs. [2] 7.000 USD/QALY [1] vs. [3] 15.000 USD/QALY | 69.000 USD | Bristol-Myers Squibb | NIVO plus IPI is cost-effective compared to NIVO and IPI |
Quon et al., 2019, Canada | [1] NIVO (1 mg/kg) + IPI (3 mg/kg) once every 3 weeks for 4 doses, then NIVO (3 mg/kg) only every 2 weeks | [2] NIVO (3 mg/kg) once every 2 weeks + placebo [3] IPI (3 mg/kg) once every 3 weeks for a total of 4 doses + placebo [4] PEMmax24 (2 mg/kg every 3 weeks) [5] PEMmaxKP (2 mg/kg every 3 weeks) | Partitioned three-state survival model (progression-free survival, survival after progression, and death) | Payer, direct costs, 20 years | Costs: 5 Effectiveness: 5 | Base case: [1] 289.085 CAND [2] 262.271 CAND [3] 139.529 CAND [4] 154.317 CAND [5] 335.634 CAND | Base case: [1] 4.05 [2] 3.48 [3] 1.81 [4] 2.47 [5] 2.47 | [1] vs. [2] 47.119 CAND/QALY (36.000 USD/QALY) [1] vs. [3] 66.750 CAND/QALY (51.000 USD/QALY) [1] vs. [4] 85.436 CAND/QALY [1] vs. [5] dominant | 100.000 CAND | Bristol-Myers Squibb | NIVO plus IPI is shown to be a cost-effective treatment compared with NIVO, IPI, and [4] PEM. Compared with NIVO plus IPI, [5] PEM represents a dominated strategy |
Wu und Shi, 2020, US | [1] NIVO (1 mg/kg) + IPI (3 mg/kg) once every 3 weeks for 4 doses, then NIVO (3 mg/kg) only every 2 weeks | [2] PEMmax48 (200 mg every 3 weeks) | Partitioned three-state survival model (progression-free survival, survival after progression, and death) | Payer, direct costs, lifelong | Costs: 3 Effectiveness: 3 | Base case: [1] 402.221 USD [2] 236.111 USD | Base case: [1] 10,031 [2] 7,368 | 125.593 USD/QALY | 150.000 USD | n.s | Based on the maximum WTP of $150,000/QALY, NIVO plus IPI is cost-effective compared to PEM |