Real-World Evidence for Option Value of Ipilimumab in Metastatic Melanoma

Study findings provide real-world evidence of measurable real option value of ipilimumab for patients with metastatic melanoma (J Manag Care Spec Pharm. 2021;1-10. doi:10.18553/jmcp.2021.21192).

“The concept of real option value suggests there is added value in treatments that extend life because they enable a patient to live long enough to benefit from future innovative treatments,” explained William B Wong, PharmD, MS, Genentech, Inc., South San Francisco, CA, and colleagues.

“Real-world evidence of this novel value element is scant, limiting its consideration in formal value assessments,” they continued.

This retrospective analysis used data from electronic health records from a US nationwide database to calculate the real option value of ipilimumab for advanced melanoma in real-world practice.

A total of 721 patients with advanced or metastatic melanoma diagnosed after January 1, 2011, who initiated treatment before April 19, 2015, and were treated with first-line ipilimumab or chemotherapy, up to availability of immunotherapy, were included in the study.

Dr Wong and colleagues calculated the proportions of surviving patients receiving immunotherapy and overall survival (OS) by line of therapy. Real option value was estimated for patients receiving first- or second-line ipilimumab or chemotherapy with or without subsequent immunotherapy.

For first-line ipilimumab, 50% of patients survived to the availability of immunotherapy vs 18% of patients who received first-line chemotherapy. For second-line ipilimumab, 37% of patients survived to availability of immunotherapy vs 21% of patients who received second-line chemotherapy. Overall, 45% of surviving patients who received first-line ipilimumab and 52% of surviving patients who received second-line ipilimumab received immunotherapy.

Real option value for first-line ipilimumab averaged 3.7 months of additional survival and those who initiated second-line ipilimumab averaged 4.8 months of additional survival. The combined estimated real option value was 3.9 months.

“This study provides real-world evidence of ROV [real option value] and adds to the growing literature that may support inclusion of this novel value concept for innovative therapies alongside more traditional measures of value,” concluded Dr Wong and colleagues.

“Further evaluation of ROV in clinical areas with varying survival and innovation is warranted,” they added.