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Cost Effectiveness of Avelumab for Metastatic Merkel Cell Carcinoma


  • Ash Bullement

    Delta Hat)

  • Paul Nathan

    (Mount Vernon Cancer Centre)

  • Anna Willis


  • Amerah Amin

    (Merck Serono)

  • Cameron Lilley


  • Ceilidh Stapelkamp

    (Merck Serono)

  • Anthony Hatswell

    (Delta Hat
    University College London)

  • Chris Pescott

    (Merck KGaA)

  • Murtuza Bharmal

    (Merck KGaA)


Background Metastatic Merkel cell carcinoma (mMCC) is a rare and aggressive skin cancer. Until recently, there were no licensed treatment options for patients with mMCC, and prognosis was poor. A cost-effectiveness analysis was conducted for avelumab, a newly available treatment option for mMCC, versus standard care (SC), from a UK National Health Service perspective. Methods A partitioned survival model was developed to assess the lifetime costs and effects of avelumab versus SC. Data from the JAVELIN Merkel 200 trial (NCT02155647) were used to inform estimates of quality-adjusted life-years (QALYs). Unit costs and associated frequencies of use were informed by published literature and clinical expert opinion. Results were presented as incremental cost-effectiveness ratios (ICERs, i.e. the cost per QALY gained) for treatment-experienced (TE) and treatment-naïve (TN) patients. Uncertainty was explored through a range of sensitivity analyses. Results Discounting costs and QALYs at 3.5% per annum, avelumab was associated with ICERs of £35,274 (TE)/£39,178 (TN) per QALY gained. Probabilistic sensitivity analysis results demonstrated that avelumab was associated with an 88.3% (TE)/69.3% (TN) probability of being cost effective at a willingness-to-pay threshold for end-of-life treatments of £50,000 per QALY gained. Results were most sensitive to alternative survival extrapolations and dosing assumptions. Conclusions The analysis results suggest that avelumab is likely to be a cost-effective treatment option for UK mMCC patients. The results for TN patients are subject to some uncertainty, and a confirmatory analysis will be conducted with more mature data.

Suggested Citation

  • Ash Bullement & Paul Nathan & Anna Willis & Amerah Amin & Cameron Lilley & Ceilidh Stapelkamp & Anthony Hatswell & Chris Pescott & Murtuza Bharmal, 2019. "Cost Effectiveness of Avelumab for Metastatic Merkel Cell Carcinoma," PharmacoEconomics - Open, Springer, vol. 3(3), pages 377-390, September.
  • Handle: RePEc:spr:pharmo:v:3:y:2019:i:3:d:10.1007_s41669-018-0115-y
    DOI: 10.1007/s41669-018-0115-y

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    References listed on IDEAS

    1. Nancy J. Devlin & Koonal K. Shah & Yan Feng & Brendan Mulhern & Ben van Hout, 2018. "Valuing health‐related quality of life: An EQ‐5D‐5L value set for England," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 7-22, January.
    2. Graeme Ball & Feng Xie & Jean-Eric Tarride, 2018. "Economic Evaluation of Bevacizumab for Treatment of Platinum-Resistant Recurrent Ovarian Cancer in Canada," PharmacoEconomics - Open, Springer, vol. 2(1), pages 19-29, March.
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    1. Zhaklin Stoykova-Valcheva, 2020. "Orphan Drugs of Personalized Medicine in Bulgaria and Their Cost-Effectiveness," Izvestia Journal of the Union of Scientists - Varna. Economic Sciences Series, Union of Scientists - Varna, Economic Sciences Section, vol. 9(3), pages 52-62, December.

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