Cost-Effectiveness of Pembrolizumab as an Adjuvant Treatment in Colombia for Melanoma Patients with Lymph Node Involvement After Complete Resection.
Humans
Cost-Benefit Analysis
Colombia
Quality of Life
Neoplasm Recurrence, Local
/ drug therapy
Melanoma
/ drug therapy
Quality-Adjusted Life Years
Adjuvants, Immunologic
/ therapeutic use
Lymph Nodes
/ pathology
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Melanoma, Cutaneous Malignant
Adjuvant treatment
Colombia
Cost-effectiveness
High-risk stage III
Latin America
Melanoma
Pembrolizumab
Journal
Advances in therapy
ISSN: 1865-8652
Titre abrégé: Adv Ther
Pays: United States
ID NLM: 8611864
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
12
12
2022
accepted:
24
02
2023
medline:
29
5
2023
pubmed:
2
5
2023
entrez:
2
5
2023
Statut:
ppublish
Résumé
The KEYNOTE-054 trial found that adjuvant treatment with pembrolizumab improved recurrence-free survival versus placebo in completely resected high-risk stage III melanoma patients. We assessed the cost-effectiveness of adjuvant pembrolizumab in Colombia compared with watchful waiting, a widely used strategy despite the high risk of recurrence with surgery alone. A four-health state [recurrence-free (RF), locoregional recurrence (LR), distant metastases (DM), and death) Markov model was developed to assess the lifetime medical costs and outcomes (3% annual discount), along with cost-effectiveness ratios (ICERs). The transitions from the RF and LR states were modeled using KEYNOTE-054 data, and those from the DM state were modeled using data from the KEYNOTE-006 trial and a network meta-analysis of advanced treatments received after adjuvant pembrolizumab and watchful waiting. The health state utilities were derived from KEYNOTE-054 Euro-QoL data and literature. Costs are expressed in 2021 Colombian pesos (COP). Over a 46-year time horizon, patients on adjuvant pembrolizumab and watchful waiting were estimated to gain 9.69 and 7.56 quality-adjusted life-years (QALYs), 10.83 and 8.65 life-years (LYs), and incur costs of COP 663,595,726 and COP 563,237,206, respectively. The proportion of LYs spent in RF state was 84.63% for pembrolizumab and 72.13% for watchful waiting, yielding lower subsequent treatment, disease management, and terminal care costs for pembrolizumab. Adjuvant pembrolizumab improved survival by 2.18 LYs and 2.13 QALYs versus watchful waiting. The ICER per QALY was COP 47,081,917, primarily driven by recurrence rates and advanced melanoma treatments. The deterministic sensitivity analysis results were robust and consistent across various reasonable inputs and alternative scenarios. At a willingness-to-pay threshold of COP 69,150,201 per QALY, the probability of pembrolizumab being cost-effective was 65.70%. Pembrolizumab is cost-effective as an adjuvant treatment compared to watchful waiting among patients with high-risk stage III melanoma after complete resection in Colombia.
Identifiants
pubmed: 37129772
doi: 10.1007/s12325-023-02484-3
pii: 10.1007/s12325-023-02484-3
pmc: PMC10219874
doi:
Substances chimiques
pembrolizumab
DPT0O3T46P
Adjuvants, Immunologic
0
Types de publication
Meta-Analysis
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
2836-2854Informations de copyright
© 2023. Merck & Co., Inc., Rahway, NJ, USA and its affiliates.
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