Cost-Effectiveness of Ipilimumab vs High-Dose Interferon for High-Risk Melanoma

While adjuvant ipilimumab increases the survival and decreases the toxicity compared to high-dose interferon in patients with resected, high-risk melanoma, it is not considered cost-effective (Cancer Med. 2021 Oct; 10[19]:6618-6626. doi:10.1002/cam4.4194).

In patients with resected, high-risk melanoma, adjuvant ipilimumab has demonstrated improvement in overall survival and reduced toxicity compared to high-dose interferon, however, the cost is substantially higher.

“This study evaluates the cost-effectiveness of ipilimumab as an adjuvant treatment in melanoma from a health care perspective,” wrote Mia Salans, MD, University of California San Diego School of Medicine, La Jolla, California, USA, and colleagues.

A Markov model was constructed to simulate patients with resected, high-risk melanoma treated with ipilimumab vs high-dose interferon. Clinical trials provided data on risks of survival, disease progression, and toxicity, while costs and quality of life measurements (health utilities) were provided through literature.

Incremental cost-effectiveness ratios (ICERs) were defined as incremental costs divided by incremental quality-adjusted life-years (QALYs). The threshold for cost-effectiveness was ICERs less than $100,000/QALY. A probabilistic sensitivity analyses was also conducted.

Results from the Markov model revealed that ipilimumab increased costs by $107,100 and increased effectiveness by 0.43 QALY, yielding an ICER of $392,600/QALY. For ipilimumab to be considered cost-effective compared to high-dose interferon, costs of ipilimumab would need to be reduced by 44%. Results from the probabilistic sensitivity analysis suggested that high-dose interferon would be cost-effective 96.2% of the time at a willingness-to-pay threshold of $100,000/QALY.

“Adjuvant ipilimumab increases the survival and decreases the toxicity compared to HDI in resected, high-risk melanoma patients,” wrote Dr Salans and colleagues, adding, “though this would not be considered cost-effective due to the high price of ipilimumab.”