Cost-Utility Analysis of Nivolumab Monotherapy for Metastatic Melanoma Treatment

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6

treatment efficacy for both regimens. The PFS curve from the PRIME trial was used as a proxy for expected duration of treatment and parametric survival analysis was used to extrapolate beyond the trial period. A mean PFS of 69.27 weeks was estimated for both regimens. The model considered the costs in the private system associated with drug acquisition, treatment administration and incidence of infusion reactions. Direct costs were obtained from literature review and local official reimbursement lists. Scenarios with or without product wastage and dose rounding were assessed. Costs for the year 2016 are expressed in Brazilian currency (BRL) and time horizon corresponds to mean PFS. Results: Panitumumab+FOLFOX is associated with a per-patient cost saving of BRL 187,479 (27.69%) compared to cetuximab+FOLFIRI in the base case scenario where wastage and a dose rounding of 10% have been considered. Acquisition costs were lower for panitumumab vs cetuximab, generating a per-patient saving of BRL 65,351 (22.54%). This represents a cost saving of BRL 18,747,852 per 100 treated patients. Using the savings associated with panitumumab utilization, 38 additional patients could be treated.  Conclusions: Panitumumab+FOLFOX provides similar OS and PFS to a smaller amount of money compared to cetuximab+FOLFIRI in the management of WT RAS mCRC patients. This analysis supports panitumumab instead of cetuximab as the preferred firstline treatment of WT RAS mCRC patients in Brazil. Cost-savings can be used to treat more patients with mCRC given a fixed budget. PCN169 Pharmacoeconomic Assessment Of Pegaspargase Versus Asparaginase in Acute Lymphocytic Leukemia Villoro R1, Aisa F2, Domenech M2, Sanz-Granda Á3, Pérez I3, Hidalgo A4, González-Domínguez A3, Dapena Díaz JL5 Max Weber, Madrid, Spain, 2Baxalta, Madrid, Spain, 3Weber Economía y Salud (WEYS), Majadahonda, Spain, 4University of Castilla-La Mancha, Toledo, Spain, 5Hospital Universitari Vall d´Hebron, Barcelona, Spain

1Instituto

Objectives: Acute Lymphoblastic Leukaemia (ALL) is the most commonly diagnosed neoplasia in patients under 15 years of age. In Spain, incidence and prevalence rates are 1.45 and 7.00 per 100,000 inhabitants per year, respectively. Native asparaginase is an effective treatment for patients with ALL, but it is associated with a high incidence of hypersensitivity reactions. When these occur, crisantaspase therapy is administered. Pegaspargase (Oncaspar®) is an asparaginase form that provides comparable efficacy to native asparaginase, lower administration frequency, and a decreased incidence of hypersensitivity reactions.  Methods: We carried out a cost minimization analysis comparing the costs native asparaginase therapy vs pegaspargase therapy. We assumed crisantaspase is administered in case of hypersensitivity reactions with any of the compared alternatives. Probabilities of hypersensitivity reactions were 41% for native asparaginase and 12% for pegaspargase. The perspective was that of the Spanish National Health System and the time horizon was 30 weeks. We included pharmaceutical costs (pegaspargase: 1 vial with 3,750 UI at 1,550€ , dose 1000 UI/m2; native asparaginase: 10 vials with 10,000 UI at 528.9€ , dose 10,000 UI/m2; crisantaspase: 10,000 UI at 3,952€ , dose 20,000 UI/m2), drug administration (47.5€ ), and hypersensitivity events management (3,622€  per episode). All transitions probabilities came from published clinical trials. Subgroup analysis was performed by risk category (standard, intermediate, and high).  Results: The average direct cost of pegaspargase therapy was similar to that of native asparaginase therapy (19,756€  vs 19,373€  per patient), while avoiding 75 episodes of hypersensitivity in the sample population. The difference in cost per patient was 867€ .  Conclusions: Treating naïve patients with ALL with pegaspargase instead of native asparaginase may lead to less hypersensitivity episodes, less administration frequency at a minimum impact in cost in Spain. PCN170 Cost Minimization Analysis of Using Pazopanib in First-Line Treatment in Patients with Metastatic Renal Cell Carcinoma Romero Prada ME1, Celis S2, Alfonso Quiñones PA3, Acero G3 Salutia, Bogotá, Colombia, 2Salutia Foundation, Bogota, Colombia, 3Salutia Foundation, Bogotá, Colombia

1Fundación

Objectives: To develop an economic evaluation of cost minimization of using pazopanib in first-line treatment for patients with metastatic renal cell carcinoma, compared with Sunitinib in the Colombian context. Since according to the literature it showed no difference in effectiveness of these two treatment alternatives.  Methods: A Markov model was designed in quarterly cycles, with a time horizon of three years for a hypothetical cohort of 1 patient diagnosed with metastatic renal cell carcinoma treated with pazopanib versus sunitinib as an alternative treatment. The analysis included the likelihood of progression to second line and progression-free survival. A sensitivity analysis was made, using different discount rates (0%, 3.5% and 10%). The outcomes were evaluated in terms of incurred costs with the use of the two treatments and cost of the adverse events. These costs were taken from Colombian health system information databases. The costs are showed in United States dollars, using current exchange rate to Colombian pesos.  Results: According to the base case analyzed in terms of costs, the use of Pazopanib has a three years cost of US $ 16,966 and Sunitinib has a cost of US $18,796 in the same time horizon, showing that Pazopanib is a thrifty technology, since it has a lower cost than Sunitinib with a difference of US $1,803 per patient. According to the sensitivity analysis it showed savings in all the scenarios. Concluding that there are more savings in total treatment costs with smaller discount rates.  Conclusions: Pazopanib is a cheaper option, which means, lower costs for the treatment and management of patients with metastatic renal cell carcinoma versus sunitinib, assuming no difference in effectiveness according to the studies reviewed. PCN171 Cost-Utility Analysis of Nivolumab Monotherapy for Metastatic Melanoma Treatment Echave M1, Oyagüez I2, Soria A3, de la Cruz-Merino L4, Arance A5, Carrasco M6, González García P6

A739

1Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain, 2Pharmacoeconomics & Outcomes Research Iberia, Pozuelo de Alarcón, Spain, 3H. Universitario Ramón y Cajal, Madrid, Spain, 4H. Virgen Macarena, Sevilla, Spain, 5H. Clinic, Barcelona, Spain, 6Bristol-Myers Squibb, Madrid, Spain

Objectives: To perform a cost-utility analysis of nivolumab versus ipilimumab, in patients with advanced, unresectable or metastatic melanoma (MM).  Methods: A partitioned survival model with three health states (progression-free, progression and death), was developed to estimate the quality-adjusted life years (QALY) gained in a lifetime horizon. Initial cohort included patients with MM receiving a first line (1L) intravenous treatment with nivolumab or ipilimumab. Clinical characteristics and BRAF+ prevalence (41%) derived from literature and were validated by oncologists. The evolution of patients was monthly modelled based on overall survival (OS) and progression free survival (PFS). Transition to progression state implied the administration of a subsequent line treatment. The dosages considered were those recommended in SmPCs for melanoma: nivolumab (3mg/kg/2 weeks until disease progression or unacceptable toxicity) and ipilimumab (3mg/kg/3 weeks, maximum 4 doses). Utilities, nivolumab clinical efficacy and adverse events (AE) frequency were obtained from CheckMate-066 trial. Ipilimumab OS was obtained from an aggregated analysis and PFS derived from CheckMate-069 where ipilimumab was the control arm versus a combination of nivolumab+ipilimumab. The National Health System perspective was considered, including direct costs (pharmaceutical costs using exfactory prices for 1L and subsequent therapies, administration, AE management costs for 1L t and patient management). A discount rate (3% annually) was applied. The health resources consumption and treatment pattern for subsequent lines were defined by oncologists. Sensitivity analyses (SA) were performed.  Results: 1L nivolumab therapy yielded more efficacy than ipilimumab (3.05 vs 1.15 QALY). The lifetime total costs of nivolumab accounted € 123,280 versus € 116,944 with ipilimumab. The incremental cost-utility ratio was € 3,242/QALY gained with nivolumab versus ipilimumab. In the probabilistic SA, 95.8% of the 1,000 simulations performed were < € 15,000/QALY gained.  Conclusions: Based on a willingness-to-pay threshold of € 30,000/QALY gained, nivolumab would be a cost-effective option compared to ipilimumab, for 1L treatment in Spanish MM patients. PCN172 Cost-Effectiveness Analysis of Gazyvaro in Association to Chlorambucil for Patients with Chronic Lymphocytic Leukemia When Full-Dose Fludarabine is Unsuitable in France Plommet N, Boissard F Roche SAS, Boulogne-Billancourt, France

Objectives: To estimate the cost-effectiveness of obinutuzumab plus Chlorambucil (GClb) versus Rituximab-Chorambucil (RClb) and Chlorambucil (Clb) based on a French perspective.  Methods: Patients outcomes were simulated using a 3-state Markov model that included PFS (progression free survival). Population simulated, corresponded to the population from CLL-11 study. Indirect treatment comparison was performed to allow the comparison of Gazyvaro plus Chlorambucil versus Rituximab plus Bendamustine. Survival time was modeled based on age-matching clinical data by using appropriate survival distribution. Costs and outcomes were discounted at an annual rate equal to 4%. Costs were assessed using different French national databases. A 10-years’ time horizon was applied. Utility values were based on UK Time trade Off study.  Results: On the 10-years’ time horizon, mean total costs were 42,840€  (GClb), 31,973€  (RClb), 14,475€  (CLB). QALYs were 3.598 (GClb), 3.067 (RClb), 2.660 (Clb). GClb improved quality adjusted life year by more than 11 months (difference of 0.938 QALY) compared to Clb and more than 6 months compared to RClb (difference of 0.531 QALY). The efficiency frontier showed that GClb is dominant by extension (more effective and more costly). The cost-effectiveness analyses showed incremental cost-effectiveness ratios (ICER) at 28,028 € / QALY (GClb vs. Clb), 20,484 € /QALY (GClb vs. RClb). Probabilistic sensitivity analysis (1,000 simulations) shown respectively ICER equal to 28,227 € /QALY [IC95%: 20 696 ; 37 718] and20,781 € /QALY [IC95%: 10,274 ; 35,487].  Conclusions: Results shown that GClb seems cost-effective versus the RClb and Clb in France, suggesting that GClb is good value for money for patients with chronic lymphocytic leukemia when full dose fludarabine is unsuitable. A French elicitation study is ongoing to confirm the consistency of these results. PCN173 Cost-Utility Analysis of Neoadjuvant Pertuzumab and Trastuzumab in Patients with Locally Advanced, Inflammatory, or Early HER-2 Positive Breast Cancer Ignatyeva V, Khachatryan G The Russian Presidential Academy of National Economy and Public Administration, Moscow, Russian Federation

Objectives: To assess the cost-utility of pertuzumab added to neoadjuvant treatment with trastuzumab and docetaxel for patients with locally advanced, inflammatory, or early HER2-positive breast cancer (BC) in Russia.  Methods: Analysis was performed from the perspective of health care payer, comparing neoadjuvant treatment with pertuzumab+trastuzumab+docetaxel and trastuzumab+docetaxel. We developed Markov model with three states: «no progression», «progression» and «death», with life time horizon and cycle length of 4 weeks. Probability of progression was based on progression-free survival obtained from NeoSphere trial of neoadjuvant pertuzumab and trastuzumab. As no data on overall survival was available, probability of death in progression was based on results of study by Slamon et al (treatment of progressive metastatic HER-2 positive BC) and in noprogression state it was the same as in general population. Utilities were derived from published literature. Only costs of chemotherapy were included into the model, based on treatment regimens in NeoSphere trial, real practice data on treatment of metastatic HER2-positive BC in Russia and registered prices for medications. Results were discounted at 3,5%. Costs were converted into EURO using the average annual exchange rate in 2015 (1 EURO= 67.7767 RUR).  Results: The results of modelling demonstrated that costs for cohort of patients treated with neoadjuvant