Cost-Effectiveness of Pembrolizumab for the Adjuvant Treatment of Melanoma Patients with Lymph Node Involvement Who Have Undergone Complete Resection in Argentina
| العنوان: | Cost-Effectiveness of Pembrolizumab for the Adjuvant Treatment of Melanoma Patients with Lymph Node Involvement Who Have Undergone Complete Resection in Argentina |
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| المؤلفون: | Victoria Wurcel, Juan Ignacio Altuna, Fernando Carabajal, Gargi Baluni, Raquel Aguiar-Ibáñez, Shrishti Jain, Emilie Scherrer |
| المصدر: | Oncology and Therapy |
| بيانات النشر: | Springer Science and Business Media LLC, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Oncology, medicine.medical_specialty, business.industry, Cost effectiveness, Melanoma, medicine.medical_treatment, Hazard ratio, Argentina, Pembrolizumab, Adjuvant treatment, medicine.disease, Confidence interval, Latin America, Internal medicine, Medicine, Cost-effectiveness, Stage (cooking), business, health care economics and organizations, Reimbursement, Watchful waiting, Original Research |
| الوصف: | Introduction The KEYNOTE-054 trial demonstrated that adjuvant pembrolizumab improves recurrence-free survival in completely resected stage III melanoma versus watchful waiting (hazard ratio [HR] = 0.57; 98.4% confidence interval [CI], 0.43–0.74). We evaluated the cost-effectiveness of pembrolizumab in Argentina, where watchful waiting is still widely used among these patients despite the high risk of recurrence with surgery alone. Methods A four-health state model was used (recurrence-free, locoregional recurrence [LR], distant metastases [DM], death). Lifetime medical costs to payers (72.08 Argentine pesos [AR$] = 1.00 U.S. dollar [USD]) and outcomes (3% annual discount) were assessed, together with incremental cost-effectiveness ratios (ICERs). First and LR→DM recurrences were modeled using KEYNOTE-054 and real-world data, respectively. No benefits of adjuvant treatment were assumed post-progression. Pre-DM and post-DM mortality was based on KEYNOTE-054 and on a network meta-analysis of advanced treatments expected in each arm, respectively. Utilities were derived from KEYNOTE-054 Euro-QoL data using an Argentinian algorithm, and from the literature. Public ex-factory drug prices were used. Results Patients in the pembrolizumab and the watchful waiting arms accrued 8.78 and 5.83 quality-adjusted life-years (QALYs), 9.91 and 6.98 life-years, and costs of AR$12,698,595 (176,174 USD) and AR$11,967,717 (166,034 USD), respectively. The proportion of life-years accrued that were recurrence-free was 80.8% and 56.9% in the pembrolizumab and the watchful waiting arms, respectively. Pembrolizumab patients gained 2.94 life-years and 2.96 QALYs versus watchful waiting; the ICER per QALY was AR$247,094 (3428 USD). Recurrence rates and advanced melanoma treatments were the key drivers of the ICER. At a threshold of AR$1,445,325 (29,935 USD) per QALY, pembrolizumab had an 83.5% probability of being cost-effective versus watchful waiting. Conclusions Adjuvant pembrolizumab after complete resection of melanoma with node involvement is highly cost-effective relative to watchful waiting in Argentina, across disease stage subgroups and BRAF mutational status. This strongly supports its coverage and reimbursement across the entire health system. |
| تدمد: | 2366-1089 2366-1070 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::37ffa07f0b556a00966d5479d4441a82Test https://doi.org/10.1007/s40487-021-00142-8Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....37ffa07f0b556a00966d5479d4441a82 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 23661089 23661070 |
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