Adjuvant IFN-α-2b for high-risk melanoma patients recommended

PharmacoEconomics & Outcomes News 298 - 3 Feb 2001 Adjuvant IFN-α-2b for high-risk melanoma patients recommended The use of adjuvant interferon (IFN)-α-2b to prolong disease-free survival in high-risk melanoma patients is cost effective in Spain and should be adopted by that country’s health system, according to researchers from Spain. * They used a Markov model to estimate the cost effectiveness of adjuvant IFN-α-2b therapy in high-risk melanoma patients from the perspective of the Spanish national health system. The model was used to calculate the costs and clinical outcomes associated with such therapy in 500 hypothetical 50-year-old patients who had undergone surgical treatment for primary cutaneous melanoma. ** The model had a time horizon of 35 years (the patients’ mean remaining lifetime). Clinical data and outcome probabilities were obtained from a randomised clinical trial (E1684) and an expert panel. In the model, patients were either observed or treated with IFN-α-2b for 1 year; IFN-α-2b was given IV 20 MU/m 2 /day 5 days/week for 1 month, then SC 10 MU/m 2 3 times weekly for 11 months. Below threshold of 20 000 euros/LYG In the base-case analysis, costs associated with IFN- α-2b therapy and observation only were 23 280 euros and 5997 euros, respectively, when discounted by 6%, and 25 487 euros and 7821 euros when undiscounted. Incremental costs associated with IFN-α-2b therapy were therefore 17 283 euros (discounted) or 17 666 euros (undiscounted). IFN-α-2b therapy resulted in a lifetime survival gain of 1.9 life-years per patient. Thus, the cost effectiveness of IFN-α-2b therapy, relative to a strategy of observation, was 9015 euros/LYG † (costs discounted) or 9215 euros/LYG (costs undiscounted). Sensitivity analyses included increasing the 5-year disease-free survival rate to the upper limit of the 95% CI reported in the E1684 trial for patients receiving observation only, while maintaining it for IFN-α-2b- treated patients. Under this scenario, the cost effectiveness of IFN-α-2b therapy increased to 21 029 euros/LYG, just over the upper limit (20 000 euros/LYG) used by the researchers to define a favourable economic outcome. Also, the cost-effectiveness ratio was 19 166 euros/LYG when both costs and health benefits were discounted at 6% per annum. * One of the researchers was from Schering-Plough, Spain. ** Costs (1998 values) included those associated with: acquisition and administration of IFN-α-2b; hospital visits, laboratory testing and other procedures (including additional visits, tests and procedures for IFN- α-2b recipients associated with follow-up and toxicity); treatment of disease recurrence (including chemotherapy, surgery, radiation therapy and palliative care); and terminal disease or death (including hospitalisation, palliative care, etc.). † life-year gained Gonz´ alez-Larriba JL, et al. Cost-effectiveness analysis of interferon as adjuvant therapy in high-risk melanoma patients in Spain. European Journal of Cancer 36: 2344-2352, Dec 2000 800855608 1 PharmacoEconomics & Outcomes News 3 Feb 2001 No. 298 1173-5503/10/0298-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Transcript of Adjuvant IFN-α-2b for high-risk melanoma patients recommended

Page 1: Adjuvant IFN-α-2b for high-risk melanoma patients recommended

PharmacoEconomics & Outcomes News 298 - 3 Feb 2001

Adjuvant IFN-α-2b for high-riskmelanoma patients recommendedThe use of adjuvant interferon (IFN)-α-2b to prolong

disease-free survival in high-risk melanoma patients iscost effective in Spain and should be adopted by thatcountry’s health system, according to researchers fromSpain.*

They used a Markov model to estimate the costeffectiveness of adjuvant IFN-α-2b therapy in high-riskmelanoma patients from the perspective of the Spanishnational health system. The model was used to calculatethe costs and clinical outcomes associated with suchtherapy in 500 hypothetical 50-year-old patients whohad undergone surgical treatment for primary cutaneousmelanoma.** The model had a time horizon of 35 years(the patients’ mean remaining lifetime). Clinical data andoutcome probabilities were obtained from a randomisedclinical trial (E1684) and an expert panel. In the model,patients were either observed or treated with IFN-α-2bfor 1 year; IFN-α-2b was given IV 20 MU/m2/day 5days/week for 1 month, then SC 10 MU/m2 3 timesweekly for 11 months.

Below threshold of 20 000 euros/LYGIn the base-case analysis, costs associated with IFN-

α-2b therapy and observation only were 23 280 eurosand 5997 euros, respectively, when discounted by 6%,and 25 487 euros and 7821 euros when undiscounted.Incremental costs associated with IFN-α-2b therapywere therefore 17 283 euros (discounted) or 17 666euros (undiscounted). IFN-α-2b therapy resulted in alifetime survival gain of 1.9 life-years per patient. Thus,the cost effectiveness of IFN-α-2b therapy, relative to astrategy of observation, was 9015 euros/LYG† (costsdiscounted) or 9215 euros/LYG (costs undiscounted).

Sensitivity analyses included increasing the 5-yeardisease-free survival rate to the upper limit of the 95% CIreported in the E1684 trial for patients receivingobservation only, while maintaining it for IFN-α-2b-treated patients. Under this scenario, the costeffectiveness of IFN-α-2b therapy increased to 21 029euros/LYG, just over the upper limit (20 000 euros/LYG)used by the researchers to define a favourable economicoutcome. Also, the cost-effectiveness ratio was 19 166euros/LYG when both costs and health benefits werediscounted at 6% per annum.* One of the researchers was from Schering-Plough, Spain.** Costs (1998 values) included those associated with: acquisition andadministration of IFN-α-2b; hospital visits, laboratory testing and otherprocedures (including additional visits, tests and procedures for IFN-α-2b recipients associated with follow-up and toxicity); treatment ofdisease recurrence (including chemotherapy, surgery, radiationtherapy and palliative care); and terminal disease or death (includinghospitalisation, palliative care, etc.).† life-year gained

Gonzalez-Larriba JL, et al. Cost-effectiveness analysis of interferon as adjuvanttherapy in high-risk melanoma patients in Spain. European Journal of Cancer 36:2344-2352, Dec 2000 800855608