nivolumab + relatlimumab与BRAF + MEK抑制剂联合一线治疗BRAF突变晚期黑色素瘤的每个结果成本。

IF 2.3 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Kirollos S Hanna, Jennell Palaia, Divya Patel, Andriy Moshyk, Zheng-Yi Zhou, Fan Yang, Yiqiao Xin, Viviana Garcia-Horton
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引用次数: 0

摘要

背景:国家综合癌症网络指南将联合免疫治疗列为不可切除或转移性黑色素瘤的首选一线(1L)治疗,而不是BRAF和MEK抑制剂(BRAFi/MEKi)治疗,无论BRAF突变状态如何。然而,nivolumab加RELA (NIVO + RELA)与BRAFi/MEKi治疗braf突变的晚期黑色素瘤的1L治疗的经济影响尚未评估。目的:比较NIVO + RELA与dabrafenib + trametinib (DAB + TRAM)、encorafenib + binimetinib (ENCO + BINI)和vemurafenib + cobimetinib (VEM + COBI)作为braf突变、不可切除或转移性黑色素瘤的1L治疗的医疗成本、每无进展生命年成本(PFLY)和每生命年成本(LY)。方法:采用成本-结果模型比较NIVO + RELA与每种BRAFi/MEKi治疗的经济价值。临床输入来自先前匹配调整的间接比较,使用来自RELATIVITY-047 braf突变亚组的个体患者数据和来自COMBI-d, COMBI-v, COLUMBUS和coBRIM的已发表数据。每个研究者的LYs、PFLYs和治疗持续时间使用限制平均生存时间估计。计算5年内的医疗保健费用(2024美元),包括药物采购和管理费用、进展前和进展后期间的疾病管理费用以及不良事件管理费用。进行了几种情景分析,包括增加后续治疗费用。结果:5年后,与DAB + TRAM(平均PFLY: 1.94 vs 1.82年,平均LY: 3.41 vs 2.77年),ENCO + BINI(分别为1.87 vs 1.78年和3.40 vs 2.91年)和VEM + COBI (2.12 vs 1.80年和3.39 vs 2.63年)相比,NIVO + RELA与改善的PFLYs和LYs相关。NIVO + RELA与DAB + TRAM(300,479美元对519,770美元)、ENCO + BINI(343,996美元对572,556美元)和VEM + COBI(296,361美元对317,851美元)的5年估计总成本较低。主要的成本驱动因素是药品采购和管理成本。NIVO + RELA的每PFLY和每LY成本低于DAB + TRAM(分别为155,107美元对285,617美元和88,203美元对187,699美元);ENCO + BINI(183,628美元对322,113美元,101,151美元对196,924美元);VEM + COBI(139,688美元对176,645美元,87,315美元对121,086美元)。敏感性分析结果支持基本情况的结果。结论:NIVO + RELA在5年内比所有3种BRAFi/MEKi比较药具有更低的成本改善了LYs和PFLYs。这些结果支持NIVO + RELA对先前未治疗、braf突变、不可切除或转移性黑色素瘤患者的经济价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost per outcome of nivolumab + relatlimab vs BRAF + MEK inhibitor combinations for first-line treatment of BRAF-mutant advanced melanoma.

Background: The National Comprehensive Cancer Network guidelines list combination immunotherapy as the preferred first-line (1L) treatment for unresectable or metastatic melanoma over BRAF and MEK inhibitor (BRAFi/MEKi) therapy, regardless of BRAF mutation status. However, the economic impact of 1L treatment with nivolumab plus relatlimab (NIVO + RELA) vs BRAFi/MEKi therapies for BRAF-mutated advanced melanoma has not been assessed.

Objective: To compare the health care costs, cost per progression-free life-year (PFLY), and cost per life-year (LY) of NIVO + RELA vs dabrafenib plus trametinib (DAB + TRAM), encorafenib plus binimetinib (ENCO + BINI), and vemurafenib plus cobimetinib (VEM + COBI) as 1L treatment for BRAF-mutated, unresectable or metastatic melanoma.

Methods: A cost-per-outcome model compared the economic value of NIVO + RELA vs each BRAFi/MEKi therapy. Clinical inputs were derived from previous matching-adjusted indirect comparisons using individual patient data from the BRAF-mutant subgroup of RELATIVITY-047 and published data pooled from COMBI-d, COMBI-v, COLUMBUS, and coBRIM. LYs, PFLYs per investigator, and treatment duration were estimated using the restricted mean survival time. Health care costs (2024 US dollars), including drug acquisition and administration costs, disease management costs over the preprogression and postprogression periods, and adverse event management costs, were calculated over 5 years. Several scenario analyses were performed, including adding subsequent treatment costs.

Results: Over 5 years, NIVO + RELA was associated with improved PFLYs and LYs compared with DAB + TRAM (mean PFLY: 1.94 vs 1.82 years, mean LY: 3.41 vs 2.77 years), ENCO + BINI (1.87 vs 1.78 years and 3.40 vs 2.91 years, respectively), and VEM + COBI (2.12 vs 1.80 years and 3.39 vs 2.63 years). The estimated total costs over 5 years were lower for NIVO + RELA vs DAB + TRAM ($300,479 vs $519,770), ENCO + BINI ($343,996 vs $572,556), and VEM + COBI ($296,361 vs $317,851). Main cost drivers were drug acquisition and administration costs. NIVO + RELA had lower costs per PFLY and per LY than DAB + TRAM ($155,107 vs $285,617 and $88,203 vs $187,699, respectively); ENCO + BINI ($183,628 vs $322,113 and $101,151 vs $196,924); and VEM + COBI ($139,688 vs $176,645 and $87,315 vs $121,086). The sensitivity analyses' results supported the base-case results.

Conclusions: NIVO + RELA showed improved LYs and PFLYs at lower cost than all 3 BRAFi/MEKi comparators over 5 years. These results support the economic value of NIVO + RELA for patients with previously untreated, BRAF-mutated, unresectable or metastatic melanoma.

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来源期刊
Journal of managed care & specialty pharmacy
Journal of managed care & specialty pharmacy Health Professions-Pharmacy
CiteScore
3.50
自引率
4.80%
发文量
131
期刊介绍: JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.
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