Cost-Effectiveness of Nivolumab in Combination with Ipilimumab in First-Line Treatment of Advanced Melanoma in Three European Countries Using 28-Month Overall Survival from Checkmate 067

OBJECTIVES: The objective of this study was to assess the cost-effectiveness of nivolumab in combination with ipilimumab (Nivo+Ipi) as first line advanced melanoma treatment across 3 European countries. METHODS: A cost-effectiveness model, using a three-state partitioned survival structure was developed.The model utilised the intent-to-treat 28-month progression-free survival data and overall survival data from the CheckMate 067 trial and a network meta-analysis which considers time-varying hazard ratios. The model utilised inputs for Greece, Spain and Portugal.The model considered a 30 year time horizon. Drug acquisition, administration, follow-up, subsequent therapy and adverse event costs were obtained via published unit prices and expert input on resource utilization. Adverse event frequencies were derived from the CheckMate 067 trial and published literature. Utility weights were also estimated from the trial, based on UK tariffs. The key comparators included in the analysis are nivolumab and ipilimumab monotherapy, however an additional comparison with pembrolizumab was considered in sensitivity analysis. RESULTS: The incremental cost per quality adjusted life years (QALY) ratios (ICUR) were consistent across the three countries. Nivo+ Ipi had an ICUR ranging from €2,488 (Greece - incremental cost €8,110, incremental QALY 3.260) to €7,311 (Spain - incremental cost €23,857, incremental QALY 3.263) compared to ipilimumab and ranging from €21,812 (Portugal - incremental cost €16,090, incremental QALY 0.738) to €28,399 (Spain - incremental cost €27,786, incremental QALY 0.978) compared to nivolumab. The differences in results were shown to be driven by subsequent treatment costs and follow-up costs. When comparing to pembrolizumab, Nivo+Ipi had the greatest QALY and life years and had an ICUR ranging from €12,323 (Greece - incremental cost €31,942, incremental QALY 2.592) and €17,962 (Spain - incremental cost €46,614, incremental QALY 2.595). CONCLUSIONS: Nivo+ Ipi represents a cost-effective option for the first-line treatment of advanced melanoma in these 3 European markets.