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

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PharmacoEconomics & Outcomes News 3 Feb 2001 No. 2981173-5503/10/0298-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved