W-16: The Cost Effectiveness of Metastatic Melanoma Treatment in Taiwan
Center For Drug Evaluation, Taiwan Taiwan
The objective of this study was to evaluate the long-term cost-effectiveness of 4 different combinations of treatment strategies for the treatment of advanced melanoma.
A Markov model containing three health states—progression free, progression, and death, was constructed with a cycle length of 3 months to simulate the lifetime progress of patients with metastatic melanoma and estimate cost and quality-adjusted life years (QALYs) and ICER.
The results showed that chemotherapy in combination with best supportive care has the lowest CE ratio. Compared with the chemotherapy in combination with best supportive care, the use of Pembrolizumab for every 3 weeks followed by the second-line drug Ipilimumab produced an incremental cost effectiveness of NT$ 6,357,690. This is higher than 3GDP in Taiwan. The first line use of Nivolumab following by Ipilimumab and the first line use of Ipilimumab followed by Nivolumab were all dominated due to higher costs and lower QALYs than the use of Pembrolizumab every 3 weeks followed by second-line Ipilimumab.
Our results concluded that 3 combination of immunotherapy are not cost-effectiveness at the willingness to pay level of 2,250,000. We suggest further studies to provide more detail on patient level information to improve the variation of parameter estimations.