Cost-effectiveness of adjuvant systemic therapies for patients with high-risk melanoma in Europe: a model-based economic evaluation

PURPOSE Interferon alfa-2b (IFN) in a randomized clinical trial (E1684) prolonged relapse-free and total survival in high-risk resected melanoma. However, the costs and toxicities of IFN are barriers to its widespread use. This study was undertaken to analyze the projected costs and long-term benefits of IFN by combining prospectively collected data on IFN actual dosage, time of recurrence, and survival with secondary data on long-term melanoma recurrence risks to project the cost-effectiveness of adjuvant IFN compared with observation. PATIENTS AND METHODS Two hypothetical cohorts of 50-year-old melanoma patients whose mean IFN dosage and clinical results were directly taken from E1684 were included in the study. Melanoma recurrence risks beyond 5 years were derived from international databases. Melanoma recurrence care costs and quality-of-life adjustments, when considered, were based on expert consensus. End points were incremental costs, life-years gained, and cost per life-year gained with and without quality-of-life adjustments. RESULTS The IFN cohort was projected to have an increased (undiscounted) survival of 0.52 years at 7 years and 1.90 years over a lifetime. The projected incremental cost (in 1996 United States dollars) per life-year gained in the IFN cohort ranged from $13,700 after 35 years to $32,600 at 7 years, the median follow-up of E1684. Using assigned quality-of-life values for IFN and recurrence, the lifetime cost per quality adjusted life-year increased to $15,200. Even if treatment costs for recurrence were excluded, the lifetime incremental cost per life-year gained was $21,600. CONCLUSION The cost and toxicity of IFN must be balanced against its projected benefits in high-risk melanoma. The derived cost-effectiveness and cost-utility ratios for IFN were comparable to other cancer interventions for which cost-effectiveness analysis has been performed.

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An Efficacy Study of Adjuvant Treatment With the Personalized Cancer Vaccine mRNA-4157 and Pembrolizumab in Patients With High-Risk Melanoma (KEYNOTE-942)

Case Medical Research ◽

10.31525/ct1-nct03897881 ◽

2019 ◽

Author(s):

Keyword(s):

High Risk ◽

Cancer Vaccine ◽

Adjuvant Treatment ◽

Efficacy Study ◽

High Risk Melanoma ◽

Risk Melanoma ◽

Personalized Cancer

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Multi‐institutional, prospective, randomized, double‐blind, placebo‐controlled phase IIb trial of the tumor lysate, particle‐loaded, dendritic cell (TLPLDC) vaccine to prevent recurrence in high‐risk melanoma patients: A subgroup analysis

Cancer Medicine ◽

10.1002/cam4.3969 ◽

2021 ◽

Author(s):

Robert C. Chick ◽

Mark B. Faries ◽

Diane F. Hale ◽

Phillip M Kemp Bohan ◽

Annelies T. Hickerson ◽

...

Keyword(s):

Dendritic Cell ◽

High Risk ◽

Subgroup Analysis ◽

Tumor Lysate ◽

Double Blind ◽

Double Blind Placebo ◽

High Risk Melanoma ◽

Risk Melanoma ◽

Melanoma Patients

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Canadian Melanoma Conference Recommendations on High-Risk Melanoma Surveillance: A Report from the 14th Annual Canadian Melanoma Conference; Banff, Alberta; 20–22 February 2020

Current Oncology ◽

10.3390/curroncol28030189 ◽

2021 ◽

Vol 28 (3) ◽

pp. 2040-2051

Author(s):

Christina W. Lee ◽

J. Gregory McKinnon ◽

Noelle Davis

Keyword(s):

High Risk ◽

Brain Magnetic Resonance Imaging ◽

Initial Therapy ◽

Expert Opinions ◽

High Risk Melanoma ◽

Novel Approach ◽

Positron Emission ◽

Risk Melanoma ◽

National Expert ◽

Melanoma Surveillance

Introduction: There are a lack of established guidelines for the surveillance of high-risk cutaneous melanoma patients following initial therapy. We describe a novel approach to the development of a national expert recommendation statement on high-risk melanoma surveillance (HRS). Methods: A consensus-based, live, online voting process was undertaken at the 13th and 14th annual Canadian Melanoma Conferences (CMC) to collect expert opinions relating to “who, what, where, and when” HRS should be conducted. Initial opinions were gathered via audience participation software and used as the basis for a second iterative questionnaire distributed online to attendees from the 13th CMC and to identified melanoma specialists from across Canada. A third questionnaire was disseminated in a similar fashion to conduct a final vote on HRS that could be implemented. Results: The majority of respondents from the first two iterative surveys agreed on stages IIB to IV as high risk. Surveillance should be conducted by an appropriate specialist, irrespective of association to a cancer centre. Frequency and modality of surveillance favoured biannual visits and Positron Emission Tomography Computed Tomography (PET/CT) with brain magnetic resonance imaging (MRI) among the systemic imaging modalities available. No consensus was initially reached regarding the frequency of systemic imaging and ultrasound of nodal basins (US). The third iterative survey resolved major areas of disagreement. A 5-year surveillance schedule was voted on with 92% of conference members in agreement. Conclusion: This final recommendation was established following 92% overall agreement among the 2020 CMC attendees.

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