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Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France

Author

Listed:
  • Marguerite Kandel

    (IGR - Institut Gustave Roussy, U1018 (Équipe 2) - Oncostat - IGR - Institut Gustave Roussy - CESP - Centre de recherche en épidémiologie et santé des populations - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - INSERM - Institut National de la Santé et de la Recherche Médicale - Université Paris-Saclay, SBE - Service de biostatistique et d'épidémiologie - Direction de la recherche clinique [Gustave Roussy] - IGR - Institut Gustave Roussy)

  • Aurélie Bardet

    (IGR - Institut Gustave Roussy, U1018 (Équipe 2) - Oncostat - IGR - Institut Gustave Roussy - CESP - Centre de recherche en épidémiologie et santé des populations - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - INSERM - Institut National de la Santé et de la Recherche Médicale - Université Paris-Saclay, SBE - Service de biostatistique et d'épidémiologie - Direction de la recherche clinique [Gustave Roussy] - IGR - Institut Gustave Roussy)

  • Stéphane Dalle

    (Centre Léon Bérard [Lyon], UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon - Centre Léon Bérard [Lyon] - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique)

  • Clara Allayous

    (Service de Dermatologie [AP-HP Hôpital Saint-Louis] - AP-HP - Hopital Saint-Louis [AP-HP] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP), HIPI (UMR_S_976 / U976) - Immunologie humaine, physiopathologie & immunothérapie - INSERM - Institut National de la Santé et de la Recherche Médicale - UPCité - Université Paris Cité)

  • Laurent Mortier

    (ONCO-THAI - Thérapies Laser Assistées par l'Image pour l'Oncologie - U 1189 - INSERM - Institut National de la Santé et de la Recherche Médicale - Université de Lille - CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille], CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille])

  • Bernard Guillot

    (CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier], UM - Université de Montpellier)

  • Caroline Dutriaux

    (CHU de Bordeaux - Centre Hospitalier Universitaire de Bordeaux)

  • Marie-Thérèse Leccia

    (CHUGA - Centre Hospitalier Universitaire [CHU Grenoble])

  • Sophie Dalac

    (Service de Dermatologie (CHU de Dijon) - CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand)

  • Henri Montaudié

    (CHU Nice - Centre Hospitalier Universitaire de Nice)

  • Philippe Saiag

    (Hôpital Ambroise Paré [AP-HP])

  • Delphine Legoupil

    (CHRU Brest - Centre Hospitalier Régional Universitaire de Brest)

  • Florence Brunet-Possenti

    (AP-HP - Hôpital Bichat - Claude Bernard [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP))

  • Jean-Philippe Arnault

    (CHU Amiens-Picardie)

  • Julie De Quatrebarbes
  • Marie Beylot-Barry

    (Hôpital Haut-Lévêque [CHU Bordeaux] - CHU Bordeaux)

  • Ève Maubec

    (Hôpital Avicenne [AP-HP] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP))

  • Thierry Lesimple

    (CRLCC - CRLCC Eugène Marquis - UNICANCER)

  • François Aubin

    (CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon)

  • Jean-Jacques Grob

    (TIMONE - Hôpital de la Timone [CHU - APHM])

  • Florence Granel-Brocard

    (Service de Dermatologie et Allergologie [CHRU Nancy] - CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy)

  • Pierre-Emmanuel Stoebner

    (CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes] - CHU Nîmes - Centre Hospitalier Universitaire de Nîmes, CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier], IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier - CRLCC Val d'Aurelle - Paul Lamarque - INSERM - Institut National de la Santé et de la Recherche Médicale - UM - Université de Montpellier)

  • Alain Dupuy

    (Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou])

  • Brigitte Dréno

    (CHU Nantes - Centre Hospitalier Universitaire de Nantes)

  • Stefan Michiels

    (IGR - Institut Gustave Roussy, SBE - Service de biostatistique et d'épidémiologie - Direction de la recherche clinique [Gustave Roussy] - IGR - Institut Gustave Roussy, U1018 (Équipe 2) - Oncostat - IGR - Institut Gustave Roussy - CESP - Centre de recherche en épidémiologie et santé des populations - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - INSERM - Institut National de la Santé et de la Recherche Médicale - Université Paris-Saclay)

  • Céleste Lebbe

    (HIPI (UMR_S_976 / U976) - Immunologie humaine, physiopathologie & immunothérapie - INSERM - Institut National de la Santé et de la Recherche Médicale - UPCité - Université Paris Cité, Service de Dermatologie [AP-HP Hôpital Saint-Louis] - AP-HP - Hopital Saint-Louis [AP-HP] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP))

  • Isabelle Borget

    (IGR - Institut Gustave Roussy, SBE - Service de biostatistique et d'épidémiologie - Direction de la recherche clinique [Gustave Roussy] - IGR - Institut Gustave Roussy, U1018 (Équipe 2) - Oncostat - IGR - Institut Gustave Roussy - CESP - Centre de recherche en épidémiologie et santé des populations - UVSQ - Université de Versailles Saint-Quentin-en-Yvelines - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Paul Brousse - INSERM - Institut National de la Santé et de la Recherche Médicale - Université Paris-Saclay, GRADES - Groupe de Recherche et d'Accueil en Droit et Economie de la Santé - Université Paris-Saclay)

Abstract

Nine drugs have been marketed for 10 years for the treatment of advanced melanoma (AM). With half of patients reaching a second line, the optimal sequence of treatments remains unclear. To inform policy-makers about their efficiency, we performed a cost-effectiveness analysis of sequential strategies in clinical practice in France, for BRAF-mutated and wild-type patients. A multistate model was developed to describe treatment sequences, associated costs, and health outcomes over 10 years. Sequences, clinical outcomes, utility scores, and economic data were extracted from the prospective Melbase cohort, collecting individual data in 1518 patients since 2013, from their AM diagnosis until their death. To adjust the differences in patients' characteristics among sequences, weighting by inverse probability was used. In the BRAF-mutated population, the MONO-targeted therapies (TT)-anti-PD1 sequence was the less expensive, whereas the anti-PD1-BI-TT sequence had an incremental cost-effectiveness ratio (ICER) of 180,441 EUR/QALY. Regarding the BRAF wild-type population, the three sequences constituted the cost-effective frontier, with ICERs ranging from 116 to 806,000 EUR/QALY. For BRAF-mutated patients, the sequence anti-PD1-BI-TT appeared to be the most efficient one in BRAF-mutated AM patients until 2018. Regarding the BRAF wild-type population until 2018, the sequence starting with IPI+NIVO appeared inefficient compared to anti-PD1, considering the extra cost for the QALY gained.

Suggested Citation

  • Marguerite Kandel & Aurélie Bardet & Stéphane Dalle & Clara Allayous & Laurent Mortier & Bernard Guillot & Caroline Dutriaux & Marie-Thérèse Leccia & Sophie Dalac & Henri Montaudié & Philippe Saiag & , 2022. "Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France," Post-Print hal-04049403, HAL.
    • Handle: RePEc:hal:journl:hal-04049403
    DOI: 10.3390/curroncol29120725
    Note: View the original document on HAL open archive server: https://hal.science/hal-04049403
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    References listed on IDEAS

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    1. Julie Chevalier & Gérard Pouvourville, 2013. "Valuing EQ-5D using Time Trade-Off in France," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 57-66, February.
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