Cost-Effectiveness of Adjuvant Nivolumab for Patients With Stage III and IV Melanoma Who Have Undergone Complete Resection in Austria

OBJECTIVES: In all age groups and social classes, people are suffering from various types of melanoma. In EU-27 countries, estimations indicate that this disease accounted for 4% of all new cancer diagnoses in 2020 and for 1.3% of all cancer-related deaths. Standard-of-care (SoC) treatment for most patients with stage III melanoma, and some people with stage IV melanoma, are tumor and associated lymph node resection followed by adjuvant systemic therapy. The aim of this analysis was to evaluate the cost-effectiveness of adjuvant nivolumab versus observation in patients with stage III and IV melanoma who have undergone complete resection in Austria.

METHODS: A partitioned survival model, comprising three health-states (recurrence-free-survival [RFS], post-recurrence, and death), with a lifetime horizon of 60 years and a cycle length of 28 days was adapted to the Austrian setting. Clinical data stems from the phase 3 “CheckMate 238” trial. Resource utilization and direct costs (2024 €) representing the Austrian payer’s perspective were derived from published sources. A willingness-to-pay threshold of 40,000€ per QALY gained was applied. A one-way sensitivity analysis and a Monte Carlo probabilistic sensitivity analysis (PSA) with 1,000 second-order simulations were performed. Costs, quality-adjusted life-years (QALYs), and LYs were discounted with 5% for costs and 3% for LYs and QALYs respectively.

RESULTS: Base case costs of nivolumab and observation amount to 143,754€ and 85,635€ over a lifetime horizon and nivolumab is associated with an incremental gain of 1.79 QALYs versus observation (11.41 versus 9.63). This leads to an incremental cost-utility ratio of 32,551€. Regarding RFS, nivolumab shows a QALY gain compared to observation (nivolumab versus observation: 8.11 versus 5.02).

CONCLUSIONS: In Austria, adjuvant nivolumab in melanoma-patients who have undergone complete resection is a cost-effective therapy option which significantly improves RFS compared to observation.