Perioperative immunotherapy for advanced resectable melanoma: a cost-effectiveness analysis

Recent studies have shown the efficacy of perioperative immunotherapy in improving the event-free survival of patients with advanced resectable melanoma. This study evaluated the cost-effectiveness of different perioperative immunotherapy treatment strategies versus adjuvant immunotherapy treatment strategies from the US payer perspective. Two immunotherapy strategies were each compared with the corresponding standard adjuvant treatment in two Markov models: Model (1) perioperative nivolumab plus ipilimumab versus adjuvant nivolumab for stage III patients; model (2) perioperative pembrolizumab versus adjuvant pembrolizumab for stage IIIB to IVC patients. Primary outcomes included direct costs, life-year gained (LYG), quality-adjusted life-year (QALY), and incremental cost per QALY (ICER). Sensitivity analyses were conducted to evaluate the robustness of the model outcomes. In base-case analysis, perioperative nivolumab plus ipilimumab (versus adjuvant nivolumab) gained higher QALY (by 2.73) with cost-saving (by USD109,157) in model (1), and perioperative pembrolizumab (versus adjuvant pembrolizumab) gained higher QALY (by 2.29) with cost-saving (by USD130,157) in model (2). Both perioperative strategies were accepted as cost-effective. One-way sensitivity analyses found the base-case results robust to variation in all model parameters at willingness-to-pay threshold of 100,000 USD/QALY. Probabilistic sensitivity analysis demonstrated that the two perioperative strategies were accepted as cost-effective in 100% of 10,000 simulations. Perioperative immunotherapies demonstrated cost-saving compared with adjuvant immunotherapies from the US payer perspective. One-way and probabilistic sensitivity analyses supported the robustness of the cost-effectiveness results. Not applicable.