PMID- 28221865
OWN - NLM
STAT- MEDLINE
DCOM- 20170728
LR  - 20181202
IS  - 1527-7755 (Electronic)
IS  - 0732-183X (Linking)
VI  - 35
IP  - 11
DP  - 2017 Apr 10
TI  - Cost-Effectiveness of Immune Checkpoint Inhibition in BRAF Wild-Type Advanced
      Melanoma.
PG  - 1194-1202
LID - 10.1200/JCO.2016.69.6336 [doi]
AB  - Purpose Patients who are diagnosed with stage IV metastatic melanoma have an
      estimated 5-year relative survival rate of only 17%. Randomized controlled trials
      of recent US Food and Drug Administration-approved immune checkpoint
      inhibitors-pembrolizumab (PEM), nivolumab (NIVO), and ipilumumab
      (IPI)-demonstrate improved patient outcomes, but the optimal treatment sequence
      in patients with BRAF wild-type metastatic melanoma remains unclear. To inform
      policy makers about the value of these treatments, we developed a Markov model to
      compare the cost-effectiveness of different strategies for sequencing novel
      agents for the treatment of advanced melanoma. Materials and Methods We developed
      Markov models by using a US-payer perspective and lifetime horizon to estimate
      costs (2016 US$) and quality-adjusted life years (QALYs) for treatment sequences 
      with first-line NIVO, IPI, NIVO + IPI, PEM every 2 weeks, and PEM every 3 weeks. 
      Health states were defined for initial treatment, first and second progression,
      and death. Rates for drug discontinuation, frequency of adverse events, disease
      progression, and death obtained from randomized phase III trials were used to
      determine the likelihood of transition between states. Deterministic and
      probabilistic sensitivity analyses were conducted to evaluate model uncertainty. 
      Results PEM every 3 weeks followed by second-line IPI was both more effective and
      less costly than dacarbazine followed by IPI then NIVO, or IPI followed by NIVO. 
      Compared with the first-line dacarbazine treatment strategy, NIVO followed by IPI
      produced an incremental cost effectiveness ratio of $90,871/QALY, and first-line 
      NIVO + IPI followed by carboplatin plus paclitaxel chemotherapy produced an
      incremental cost effectiveness ratio of $198,867/QALY. Conclusion For patients
      with treatment-naive BRAF wild-type advanced melanoma, first-line PEM every 3
      weeks followed by second-line IPI or first-line NIVO followed by second-line IPI 
      are the most cost-effective, immune-based treatment strategies for metastatic
      melanoma.
FAU - Kohn, Christine G
AU  - Kohn CG
AD  - Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G.
      Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center,
      Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers,
      Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of
      Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and
      Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva,
      Israel.
FAU - Zeichner, Simon B
AU  - Zeichner SB
AD  - Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G.
      Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center,
      Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers,
      Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of
      Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and
      Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva,
      Israel.
FAU - Chen, Qiushi
AU  - Chen Q
AD  - Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G.
      Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center,
      Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers,
      Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of
      Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and
      Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva,
      Israel.
FAU - Montero, Alberto J
AU  - Montero AJ
AD  - Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G.
      Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center,
      Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers,
      Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of
      Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and
      Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva,
      Israel.
FAU - Goldstein, Daniel A
AU  - Goldstein DA
AD  - Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G.
      Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center,
      Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers,
      Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of
      Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and
      Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva,
      Israel.
FAU - Flowers, Christopher R
AU  - Flowers CR
AD  - Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G.
      Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center,
      Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers,
      Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of
      Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and
      Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva,
      Israel.
LA  - eng
GR  - K24 CA208132/CA/NCI NIH HHS/United States
PT  - Journal Article
DEP - 20170221
PL  - United States
TA  - J Clin Oncol
JT  - Journal of clinical oncology : official journal of the American Society of
      Clinical Oncology
JID - 8309333
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Ipilimumab)
RN  - 31YO63LBSN (Nivolumab)
RN  - 7GR28W0FJI (Dacarbazine)
RN  - BG3F62OND5 (Carboplatin)
RN  - DPT0O3T46P (pembrolizumab)
RN  - EC 2.7.11.1 (BRAF protein, human)
RN  - EC 2.7.11.1 (Proto-Oncogene Proteins B-raf)
RN  - P88XT4IS4D (Paclitaxel)
SB  - IM
CIN - J Clin Oncol. 2017 Sep 10;35(26):3085-3086. PMID: 28715247
CIN - J Clin Oncol. 2017 Sep 10;35(26):3086-3087. PMID: 28715248
MH  - Antibodies, Monoclonal/administration & dosage/economics
MH  - Antibodies, Monoclonal, Humanized/administration & dosage/economics
MH  - Antineoplastic Combined Chemotherapy Protocols/adverse
      effects/*economics/*therapeutic use
MH  - Carboplatin/administration & dosage/economics
MH  - *Cell Cycle Checkpoints
MH  - Clinical Trials, Phase III as Topic
MH  - Cost-Benefit Analysis
MH  - Dacarbazine/administration & dosage/economics
MH  - Disease-Free Survival
MH  - Drug-Related Side Effects and Adverse Reactions/economics
MH  - Health Care Costs/*statistics & numerical data
MH  - Humans
MH  - Ipilimumab
MH  - *Markov Chains
MH  - Melanoma/*drug therapy/genetics/pathology
MH  - Models, Economic
MH  - Nivolumab
MH  - Paclitaxel/administration & dosage/economics
MH  - Proto-Oncogene Proteins B-raf/*genetics
MH  - Quality-Adjusted Life Years
MH  - Randomized Controlled Trials as Topic
MH  - Survival Rate
PMC - PMC5791832
EDAT- 2017/02/22 06:00
MHDA- 2017/07/29 06:00
CRDT- 2017/02/22 06:00
PHST- 2017/02/22 06:00 [pubmed]
PHST- 2017/07/29 06:00 [medline]
PHST- 2017/02/22 06:00 [entrez]
AID - 10.1200/JCO.2016.69.6336 [doi]
PST - ppublish
SO  - J Clin Oncol. 2017 Apr 10;35(11):1194-1202. doi: 10.1200/JCO.2016.69.6336. Epub
      2017 Feb 21.