Multiple treatment comparison of seven new drugs for patients with advanced malignant melanoma: a systematic review and health economic decision model in a Norwegian setting
ObjectiveTo assess the relative effectiveness and cost-effectiveness of seven new drugs (cobimetinib, dabrafenib, ipilimumab, nivolumab, pembrolizumab, trametinib and vemurafenib) used for treatment of patients with advanced malignant melanoma in the Norwegian setting.DesignA multiple technology ass...
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| creator | Pike, Eva Hamidi, Vida Saeterdal, Ingvil Odgaard-Jensen, Jan Klemp, Marianne |
| description | ObjectiveTo assess the relative effectiveness and cost-effectiveness of seven new drugs (cobimetinib, dabrafenib, ipilimumab, nivolumab, pembrolizumab, trametinib and vemurafenib) used for treatment of patients with advanced malignant melanoma in the Norwegian setting.DesignA multiple technology assessment.PatientsPatients with advanced malignant melanoma aged 18 or older.Data sourcesA systematic search for randomised controlled trials in relevant bibliographic databases.MethodsWe performed network meta-analyses using both direct and indirect evidence with dacarbazine as a common comparator. We ranked the different treatments in terms of their likelihood of leading to the best results for each endpoint. The cost-utility analysis was based on a probabilistic discrete-time Markov cohort model. The model calculated the costs and quality-adjusted life years (QALYs) with different treatment strategies from a healthcare perspective. Sensitivity analysis was performed by means of Monte Carlo simulation.ResultsMonotherapies with a programmed cell death 1 (PD-1) immune-checkpoint-inhibitor had a higher probability of good performance for overall survival than monotherapies with ipilimumab or BRAF/MEK inhibitors. The combination treatments had all similar levels of effectiveness to the PD-1 immune-checkpoint-inhibitors.PD-1 immune-checkpoint-inhibitors are more effective and more costly compared with ipilimumab in monotherapy. Nivolumab in combination with ipilimumab had higher costs and the same level of effectiveness as the PD-1 immune-checkpoint-inhibitors in monotherapy.BRAF/MEK inhibitor combinations (dabrafenib and trametinib or vemurafenib and cobimetinib) had both similar effectiveness and cost-effectiveness; however, the combination therapies are more likely to give higher quality adjusted life year gains than BRAF or MEK inhibitor monotherapies, but to a higher cost.ConclusionsNone of the drugs investigated can be considered cost-effective at what has normally been considered a reasonable willingness-to-pay (WTP) in Norway. Price reductions (from the official list prices) in the region of 63%–84% would be necessary for these drugs to be cost-effective at a WTP of €55 850 per QALY. |
| doi_str_mv | 10.1136/bmjopen-2016-014880 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5724191</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1931130445</sourcerecordid><originalsourceid>FETCH-LOGICAL-b496t-65640f7723bbcd6d26b6a5f3ad8100431d0d96c8230b07ba1bd629fb73a7494d3</originalsourceid><addsrcrecordid>eNqNUk1v1DAQjRCIVqW_AAkscU6xndhJOCChii-pwAXO1jh2sl7FdrC9u-qP4j8y1W6rcsMXW5r33rzxvKp6yegVY418q_02rjbUnDJZU9b2PX1SnXPatrWkQjx99D6rLnPeUjytGITgz6sz3ve84017Xv35tluKWxdLSrJQvA2FjNGvkFyOgcSJZLu3gQR7ICbt5kymmMgKxSEyk4MrGwJmD2G0hnhY3BwAJbxdIEQP7wiQfJuL9cgYSbJ7h0IQDNlYWJBrx4g4LBk7uuywpY_GLsQFZH6P6WBnBwFNlOLC_KJ6NsGS7eXpvqh-ffr48_pLffPj89frDze1bgdZailkS6cOJ9R6NNJwqSWIqQHTM_yFhhlqBjn2vKGadhqYNpIPk-4a6NqhNc1F9f6ou-60t2bEWRMsak3OQ7pVEZz6txLcRs1xr0THWzYwFHh9FBjxH9G5CjGBYrQXXIleMI6IN6cWKf7e2VzUNu5SwKkUGxrcMa5PIKq514k5Jzs9eGBU3QVBnYKg7oKgjkFA1qvH9h8492tHwNURgOz_UvwLU43CuA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1931130445</pqid></control><display><type>article</type><title>Multiple treatment comparison of seven new drugs for patients with advanced malignant melanoma: a systematic review and health economic decision model in a Norwegian setting</title><source>BMJ Open Access Journals</source><source>MEDLINE</source><source>NORA - Norwegian Open Research Archives</source><source>DOAJ Directory of Open Access Journals</source><source>PubMed Central Open Access</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Pike, Eva ; Hamidi, Vida ; Saeterdal, Ingvil ; Odgaard-Jensen, Jan ; Klemp, Marianne</creator><creatorcontrib>Pike, Eva ; Hamidi, Vida ; Saeterdal, Ingvil ; Odgaard-Jensen, Jan ; Klemp, Marianne</creatorcontrib><description>ObjectiveTo assess the relative effectiveness and cost-effectiveness of seven new drugs (cobimetinib, dabrafenib, ipilimumab, nivolumab, pembrolizumab, trametinib and vemurafenib) used for treatment of patients with advanced malignant melanoma in the Norwegian setting.DesignA multiple technology assessment.PatientsPatients with advanced malignant melanoma aged 18 or older.Data sourcesA systematic search for randomised controlled trials in relevant bibliographic databases.MethodsWe performed network meta-analyses using both direct and indirect evidence with dacarbazine as a common comparator. We ranked the different treatments in terms of their likelihood of leading to the best results for each endpoint. The cost-utility analysis was based on a probabilistic discrete-time Markov cohort model. The model calculated the costs and quality-adjusted life years (QALYs) with different treatment strategies from a healthcare perspective. Sensitivity analysis was performed by means of Monte Carlo simulation.ResultsMonotherapies with a programmed cell death 1 (PD-1) immune-checkpoint-inhibitor had a higher probability of good performance for overall survival than monotherapies with ipilimumab or BRAF/MEK inhibitors. The combination treatments had all similar levels of effectiveness to the PD-1 immune-checkpoint-inhibitors.PD-1 immune-checkpoint-inhibitors are more effective and more costly compared with ipilimumab in monotherapy. Nivolumab in combination with ipilimumab had higher costs and the same level of effectiveness as the PD-1 immune-checkpoint-inhibitors in monotherapy.BRAF/MEK inhibitor combinations (dabrafenib and trametinib or vemurafenib and cobimetinib) had both similar effectiveness and cost-effectiveness; however, the combination therapies are more likely to give higher quality adjusted life year gains than BRAF or MEK inhibitor monotherapies, but to a higher cost.ConclusionsNone of the drugs investigated can be considered cost-effective at what has normally been considered a reasonable willingness-to-pay (WTP) in Norway. Price reductions (from the official list prices) in the region of 63%–84% would be necessary for these drugs to be cost-effective at a WTP of €55 850 per QALY.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2016-014880</identifier><identifier>PMID: 28827234</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Antibodies, Monoclonal - therapeutic use ; Antineoplastic Agents - economics ; Antineoplastic Agents - therapeutic use ; Cancer therapies ; Chemotherapy ; Cost-Benefit Analysis ; Dacarbazine - therapeutic use ; Drug Costs - statistics & numerical data ; Drug Therapy, Combination ; Drugs ; Evidence-based medicine ; Humans ; Immune system ; Immunotherapy ; Inhibitor drugs ; Inhibitors ; Ipilimumab - therapeutic use ; Kinases ; Ligands ; Medical prognosis ; Melanoma ; Melanoma - drug therapy ; Melanoma - mortality ; Metastasis ; Models, Economic ; Monoclonal antibodies ; Monte Carlo simulation ; Mutation ; Network Meta-Analysis ; Nivolumab ; Norway ; Pharmaceutical industry ; Pharmacology and Therapeutics ; Proteins ; Quality of life ; Quality-Adjusted Life Years ; Randomized Controlled Trials as Topic ; Sensitivity analysis ; Skin cancer ; Substance abuse treatment ; Survival Analysis ; Systematic review ; Targeted cancer therapy ; Technology assessment</subject><ispartof>BMJ open, 2017-08, Vol.7 (8), p.e014880</ispartof><rights>Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.</rights><rights>2017 Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b496t-65640f7723bbcd6d26b6a5f3ad8100431d0d96c8230b07ba1bd629fb73a7494d3</citedby><cites>FETCH-LOGICAL-b496t-65640f7723bbcd6d26b6a5f3ad8100431d0d96c8230b07ba1bd629fb73a7494d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmjopen.bmj.com/content/7/8/e014880.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmjopen.bmj.com/content/7/8/e014880.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,26566,27548,27549,27923,27924,53790,53792,77472,77503</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28827234$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pike, Eva</creatorcontrib><creatorcontrib>Hamidi, Vida</creatorcontrib><creatorcontrib>Saeterdal, Ingvil</creatorcontrib><creatorcontrib>Odgaard-Jensen, Jan</creatorcontrib><creatorcontrib>Klemp, Marianne</creatorcontrib><title>Multiple treatment comparison of seven new drugs for patients with advanced malignant melanoma: a systematic review and health economic decision model in a Norwegian setting</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectiveTo assess the relative effectiveness and cost-effectiveness of seven new drugs (cobimetinib, dabrafenib, ipilimumab, nivolumab, pembrolizumab, trametinib and vemurafenib) used for treatment of patients with advanced malignant melanoma in the Norwegian setting.DesignA multiple technology assessment.PatientsPatients with advanced malignant melanoma aged 18 or older.Data sourcesA systematic search for randomised controlled trials in relevant bibliographic databases.MethodsWe performed network meta-analyses using both direct and indirect evidence with dacarbazine as a common comparator. We ranked the different treatments in terms of their likelihood of leading to the best results for each endpoint. The cost-utility analysis was based on a probabilistic discrete-time Markov cohort model. The model calculated the costs and quality-adjusted life years (QALYs) with different treatment strategies from a healthcare perspective. Sensitivity analysis was performed by means of Monte Carlo simulation.ResultsMonotherapies with a programmed cell death 1 (PD-1) immune-checkpoint-inhibitor had a higher probability of good performance for overall survival than monotherapies with ipilimumab or BRAF/MEK inhibitors. The combination treatments had all similar levels of effectiveness to the PD-1 immune-checkpoint-inhibitors.PD-1 immune-checkpoint-inhibitors are more effective and more costly compared with ipilimumab in monotherapy. Nivolumab in combination with ipilimumab had higher costs and the same level of effectiveness as the PD-1 immune-checkpoint-inhibitors in monotherapy.BRAF/MEK inhibitor combinations (dabrafenib and trametinib or vemurafenib and cobimetinib) had both similar effectiveness and cost-effectiveness; however, the combination therapies are more likely to give higher quality adjusted life year gains than BRAF or MEK inhibitor monotherapies, but to a higher cost.ConclusionsNone of the drugs investigated can be considered cost-effective at what has normally been considered a reasonable willingness-to-pay (WTP) in Norway. Price reductions (from the official list prices) in the region of 63%–84% would be necessary for these drugs to be cost-effective at a WTP of €55 850 per QALY.</description><subject>Antibodies, Monoclonal - therapeutic use</subject><subject>Antineoplastic Agents - economics</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Cost-Benefit Analysis</subject><subject>Dacarbazine - therapeutic use</subject><subject>Drug Costs - statistics & numerical data</subject><subject>Drug Therapy, Combination</subject><subject>Drugs</subject><subject>Evidence-based medicine</subject><subject>Humans</subject><subject>Immune system</subject><subject>Immunotherapy</subject><subject>Inhibitor drugs</subject><subject>Inhibitors</subject><subject>Ipilimumab - therapeutic use</subject><subject>Kinases</subject><subject>Ligands</subject><subject>Medical prognosis</subject><subject>Melanoma</subject><subject>Melanoma - drug therapy</subject><subject>Melanoma - mortality</subject><subject>Metastasis</subject><subject>Models, Economic</subject><subject>Monoclonal antibodies</subject><subject>Monte Carlo simulation</subject><subject>Mutation</subject><subject>Network Meta-Analysis</subject><subject>Nivolumab</subject><subject>Norway</subject><subject>Pharmaceutical industry</subject><subject>Pharmacology and Therapeutics</subject><subject>Proteins</subject><subject>Quality of life</subject><subject>Quality-Adjusted Life Years</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Sensitivity analysis</subject><subject>Skin cancer</subject><subject>Substance abuse treatment</subject><subject>Survival Analysis</subject><subject>Systematic review</subject><subject>Targeted cancer therapy</subject><subject>Technology assessment</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>3HK</sourceid><recordid>eNqNUk1v1DAQjRCIVqW_AAkscU6xndhJOCChii-pwAXO1jh2sl7FdrC9u-qP4j8y1W6rcsMXW5r33rzxvKp6yegVY418q_02rjbUnDJZU9b2PX1SnXPatrWkQjx99D6rLnPeUjytGITgz6sz3ve84017Xv35tluKWxdLSrJQvA2FjNGvkFyOgcSJZLu3gQR7ICbt5kymmMgKxSEyk4MrGwJmD2G0hnhY3BwAJbxdIEQP7wiQfJuL9cgYSbJ7h0IQDNlYWJBrx4g4LBk7uuywpY_GLsQFZH6P6WBnBwFNlOLC_KJ6NsGS7eXpvqh-ffr48_pLffPj89frDze1bgdZailkS6cOJ9R6NNJwqSWIqQHTM_yFhhlqBjn2vKGadhqYNpIPk-4a6NqhNc1F9f6ou-60t2bEWRMsak3OQ7pVEZz6txLcRs1xr0THWzYwFHh9FBjxH9G5CjGBYrQXXIleMI6IN6cWKf7e2VzUNu5SwKkUGxrcMa5PIKq514k5Jzs9eGBU3QVBnYKg7oKgjkFA1qvH9h8492tHwNURgOz_UvwLU43CuA</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Pike, Eva</creator><creator>Hamidi, Vida</creator><creator>Saeterdal, Ingvil</creator><creator>Odgaard-Jensen, Jan</creator><creator>Klemp, Marianne</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>3HK</scope><scope>5PM</scope></search><sort><creationdate>20170801</creationdate><title>Multiple treatment comparison of seven new drugs for patients with advanced malignant melanoma: a systematic review and health economic decision model in a Norwegian setting</title><author>Pike, Eva ; Hamidi, Vida ; Saeterdal, Ingvil ; Odgaard-Jensen, Jan ; Klemp, Marianne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b496t-65640f7723bbcd6d26b6a5f3ad8100431d0d96c8230b07ba1bd629fb73a7494d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Antibodies, Monoclonal - therapeutic use</topic><topic>Antineoplastic Agents - economics</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Cost-Benefit Analysis</topic><topic>Dacarbazine - therapeutic use</topic><topic>Drug Costs - statistics & numerical data</topic><topic>Drug Therapy, Combination</topic><topic>Drugs</topic><topic>Evidence-based medicine</topic><topic>Humans</topic><topic>Immune system</topic><topic>Immunotherapy</topic><topic>Inhibitor drugs</topic><topic>Inhibitors</topic><topic>Ipilimumab - therapeutic use</topic><topic>Kinases</topic><topic>Ligands</topic><topic>Medical prognosis</topic><topic>Melanoma</topic><topic>Melanoma - drug therapy</topic><topic>Melanoma - mortality</topic><topic>Metastasis</topic><topic>Models, Economic</topic><topic>Monoclonal antibodies</topic><topic>Monte Carlo simulation</topic><topic>Mutation</topic><topic>Network Meta-Analysis</topic><topic>Nivolumab</topic><topic>Norway</topic><topic>Pharmaceutical industry</topic><topic>Pharmacology and Therapeutics</topic><topic>Proteins</topic><topic>Quality of life</topic><topic>Quality-Adjusted Life Years</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Sensitivity analysis</topic><topic>Skin cancer</topic><topic>Substance abuse treatment</topic><topic>Survival Analysis</topic><topic>Systematic review</topic><topic>Targeted cancer therapy</topic><topic>Technology assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pike, Eva</creatorcontrib><creatorcontrib>Hamidi, Vida</creatorcontrib><creatorcontrib>Saeterdal, Ingvil</creatorcontrib><creatorcontrib>Odgaard-Jensen, Jan</creatorcontrib><creatorcontrib>Klemp, Marianne</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pike, Eva</au><au>Hamidi, Vida</au><au>Saeterdal, Ingvil</au><au>Odgaard-Jensen, Jan</au><au>Klemp, Marianne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multiple treatment comparison of seven new drugs for patients with advanced malignant melanoma: a systematic review and health economic decision model in a Norwegian setting</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>7</volume><issue>8</issue><spage>e014880</spage><pages>e014880-</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectiveTo assess the relative effectiveness and cost-effectiveness of seven new drugs (cobimetinib, dabrafenib, ipilimumab, nivolumab, pembrolizumab, trametinib and vemurafenib) used for treatment of patients with advanced malignant melanoma in the Norwegian setting.DesignA multiple technology assessment.PatientsPatients with advanced malignant melanoma aged 18 or older.Data sourcesA systematic search for randomised controlled trials in relevant bibliographic databases.MethodsWe performed network meta-analyses using both direct and indirect evidence with dacarbazine as a common comparator. We ranked the different treatments in terms of their likelihood of leading to the best results for each endpoint. The cost-utility analysis was based on a probabilistic discrete-time Markov cohort model. The model calculated the costs and quality-adjusted life years (QALYs) with different treatment strategies from a healthcare perspective. Sensitivity analysis was performed by means of Monte Carlo simulation.ResultsMonotherapies with a programmed cell death 1 (PD-1) immune-checkpoint-inhibitor had a higher probability of good performance for overall survival than monotherapies with ipilimumab or BRAF/MEK inhibitors. The combination treatments had all similar levels of effectiveness to the PD-1 immune-checkpoint-inhibitors.PD-1 immune-checkpoint-inhibitors are more effective and more costly compared with ipilimumab in monotherapy. Nivolumab in combination with ipilimumab had higher costs and the same level of effectiveness as the PD-1 immune-checkpoint-inhibitors in monotherapy.BRAF/MEK inhibitor combinations (dabrafenib and trametinib or vemurafenib and cobimetinib) had both similar effectiveness and cost-effectiveness; however, the combination therapies are more likely to give higher quality adjusted life year gains than BRAF or MEK inhibitor monotherapies, but to a higher cost.ConclusionsNone of the drugs investigated can be considered cost-effective at what has normally been considered a reasonable willingness-to-pay (WTP) in Norway. Price reductions (from the official list prices) in the region of 63%–84% would be necessary for these drugs to be cost-effective at a WTP of €55 850 per QALY.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>28827234</pmid><doi>10.1136/bmjopen-2016-014880</doi><oa>free_for_read</oa></addata></record> |
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| source | BMJ Open Access Journals; MEDLINE; NORA - Norwegian Open Research Archives; DOAJ Directory of Open Access Journals; PubMed Central Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Antibodies, Monoclonal - therapeutic use Antineoplastic Agents - economics Antineoplastic Agents - therapeutic use Cancer therapies Chemotherapy Cost-Benefit Analysis Dacarbazine - therapeutic use Drug Costs - statistics & numerical data Drug Therapy, Combination Drugs Evidence-based medicine Humans Immune system Immunotherapy Inhibitor drugs Inhibitors Ipilimumab - therapeutic use Kinases Ligands Medical prognosis Melanoma Melanoma - drug therapy Melanoma - mortality Metastasis Models, Economic Monoclonal antibodies Monte Carlo simulation Mutation Network Meta-Analysis Nivolumab Norway Pharmaceutical industry Pharmacology and Therapeutics Proteins Quality of life Quality-Adjusted Life Years Randomized Controlled Trials as Topic Sensitivity analysis Skin cancer Substance abuse treatment Survival Analysis Systematic review Targeted cancer therapy Technology assessment |
| title | Multiple treatment comparison of seven new drugs for patients with advanced malignant melanoma: a systematic review and health economic decision model in a Norwegian setting |
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