{"id":15401,"date":"2023-03-31T00:00:00","date_gmt":"2023-03-31T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/publications\/journal-articles\/cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma-a-real-world-population-based-cohort-study-of-resource-utilization\/"},"modified":"2023-09-20T12:59:51","modified_gmt":"2023-09-20T16:59:51","slug":"cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma-a-real-world-population-based-cohort-study-of-resource-utilization","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma-a-real-world-population-based-cohort-study-of-resource-utilization\/","title":{"rendered":"Cost-effectiveness of second-line ipilimumab for metastatic melanoma: a real-world population-based cohort study of resource utilization"},"content":{"rendered":"<p><strong>Background<\/strong> &#x2014; The efficacy-effectiveness gap between randomized trial and real-world evidence regarding the clinical benefit of ipilimumab for metastatic melanoma (MM) has been well characterized by previous literature, consistent with initial concerns raised by health technology assessment agencies (HTAs). As these differences can significantly impact cost-effectiveness, it is critical to assess the real-world cost-effectiveness of second-line ipilimumab versus non-ipilimumab treatments for MM.<\/p>\n<p><strong>Methods<\/strong> &#x2014; This was a population-based retrospective cohort study of patients who received second-line non-ipilimumab therapies between 2008 and 2012 versus ipilimumab treatment between 2012 and 2015 (after public reimbursement) for MM in Ontario. Using a 5-year time horizon, censor-adjusted and discounted (1.5%) costs (from the public payer&apos;s perspective in Canadian dollars) and effectiveness were used to calculate incremental cost-effectiveness ratios (ICERs) in life-years gained (LYGs) and quality-adjusted life years (QALYs), with bootstrapping to capture uncertainty. Varying the discount rate and reducing the price of ipilimumab were done as sensitivity analyses.<\/p>\n<p><strong>Results<\/strong> &#x2014; In total, 329 MM were identified (Treated: 189; Controls: 140). Ipilimumab was associated with an incremental effectiveness of 0.59 LYG, incremental cost of &#x24;91,233, and ICER of &#x24;153,778\/LYG. ICERs were not sensitive to discounting rate. Adjusting for quality of life using utility weights resulted in an ICER of &#x24;225,885\/QALY, confirming the original HTA estimate prior to public reimbursement. Reducing the price of ipilimumab by 100% resulted in an ICER of &#x24;111,728\/QALY.<\/p>\n<p><strong>Conclusion<\/strong> &#x2014; Despite its clinical benefit, ipilimumab as second-line monotherapy for MM patients is not cost-effective in the real world as projected by HTA under conventional willingness-to-pay thresholds.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; The efficacy-effectiveness gap between randomized trial and real-world evidence regarding the clinical benefit of ipilimumab for metastatic melanoma (MM) has been well characterized by previous literature, consistent with initial concerns raised by health technology assessment agencies (HTAs). As these differences can significantly impact cost-effectiveness, it is critical to assess the real-world cost-effectiveness of [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-15401","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Lu B, Dai WF, Croxford R, Isaranuwatchai W, Beca J, Menjak IB, Petrella TM, Mittmann N, Earle CC, Gavura S, Mercer RE, Hanna TP, Chan KKW. <em>Cancer Med<\/em>. 2023; 12(10):11451-61. Epub 2023 Mar 31.","source_url":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.5862","ices_scientist":[1225,1185,1263],"site":[6733],"research_program":[6741],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"168534D3-FE5D-4C7A-9E3F-7E2EA095271D","sitecore_item_name":"Cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma","sitecore_field_values":"{\n  \"Title\": \"Cost-effectiveness of second-line ipilimumab for metastatic melanoma: a real-world population-based cohort study of resource utilization\",\n  \"Short title\": \"Cost-effectiveness of second-line\",\n  \"Summary\": \"This study found that despite its clinical benefit, ipilimumab as second-line monotherapy for metastatic melanoma patients is not cost-effective in the real world.\",\n  \"Citation\": \"<p>Lu B, Dai WF, Croxford R, Isaranuwatchai W, Beca J, Menjak IB, Petrella TM, Mittmann N, Earle CC, Gavura S, Mercer RE, Hanna TP, Chan KKW. <em>Cancer Med<\/em>. 2023; Mar 31 [Epub ahead of print]. DOI: <a href=\"https:\/\/doi.org\/10.1002\/cam4.5862\" title=\"opens external link\">https:\/\/doi.org\/10.1002\/cam4.5862<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Background<\/strong> &mdash; The efficacy-effectiveness gap between randomized trial and real-world evidence regarding the clinical benefit of ipilimumab for metastatic melanoma (MM) has been well characterized by previous literature, consistent with initial concerns raised by health technology assessment agencies (HTAs). As these differences can significantly impact cost-effectiveness, it is critical to assess the real-world cost-effectiveness of second-line ipilimumab versus non-ipilimumab treatments for MM.<\/p>n<p><strong>Methods<\/strong> &mdash; This was a population-based retrospective cohort study of patients who received second-line non-ipilimumab therapies between 2008 and 2012 versus ipilimumab treatment between 2012 and 2015 (after public reimbursement) for MM in Ontario. Using a 5-year time horizon, censor-adjusted and discounted (1.5%) costs (from the public payer's perspective in Canadian dollars) and effectiveness were used to calculate incremental cost-effectiveness ratios (ICERs) in life-years gained (LYGs) and quality-adjusted life years (QALYs), with bootstrapping to capture uncertainty. Varying the discount rate and reducing the price of ipilimumab were done as sensitivity analyses.<\/p>n<p><strong>Results<\/strong> &mdash; In total, 329 MM were identified (Treated: 189; Controls: 140). Ipilimumab was associated with an incremental effectiveness of 0.59 LYG, incremental cost of $91,233, and ICER of $153,778\/LYG. ICERs were not sensitive to discounting rate. Adjusting for quality of life using utility weights resulted in an ICER of $225,885\/QALY, confirming the original HTA estimate prior to public reimbursement. Reducing the price of ipilimumab by 100% resulted in an ICER of $111,728\/QALY.<\/p>n<p><strong>Conclusion<\/strong> &mdash; Despite its clinical benefit, ipilimumab as second-line monotherapy for MM patients is not cost-effective in the real world as projected by HTA under conventional willingness-to-pay thresholds.<\/p>n<p><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.5862\" title=\"opens external link\">View full text<\/a><\/p>\",\n  \"Research Programs\": \"{85DE96A6-4C96-40C7-8E6D-7597A0EB5F80}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{B3A5A166-8F3C-43DC-8214-EFB653814F22}|{52FF4CDE-7397-4135-8760-839196429B7D}|{717271E6-3DC5-4E53-8979-3AB613192828}\",\n  \"Posted Date\": \"20230331T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2023\/March\/Cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Cost-effectiveness of second-line ipilimumab for metastatic melanoma: a real-world population-based cohort study of resource utilization<\/title>\n<meta name=\"description\" content=\"Background &#x2014; The efficacy-effectiveness gap between randomized trial and real-world evidence regarding the clinical benefit of ipilimumab for\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma-a-real-world-population-based-cohort-study-of-resource-utilization\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Cost-effectiveness of second-line ipilimumab for metastatic melanoma: a real-world population-based cohort study of resource utilization\" \/>\n<meta property=\"og:description\" content=\"Background &#x2014; The efficacy-effectiveness gap between randomized trial and real-world evidence regarding the clinical benefit of ipilimumab for\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma-a-real-world-population-based-cohort-study-of-resource-utilization\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-09-20T16:59:51+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma-a-real-world-population-based-cohort-study-of-resource-utilization\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/cost-effectiveness-of-second-line-ipilimumab-for-metastatic-melanoma-a-real-world-population-based-cohort-study-of-resource-utilization\\\/\",\"name\":\"ICES | Cost-effectiveness of second-line ipilimumab for metastatic melanoma: a real-world population-based cohort study of resource utilization\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2023-03-31T04:00:00+00:00\",\"dateModified\":\"2023-09-20T16:59:51+00:00\",\"description\":\"Background &#x2014; 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