Clinical and economic evaluation of atezolizumab + vemurafenib + cobimetinib combination and nivolumab + ipilimumab combination: administration in metastatic melanoma treatment with BRAF-confirmed mutation in adult patients

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Abstract

The aim of the study was to conduct a pharmacoeconomic evaluation of the atezolizumab, vemurofenib and cobimetinib (ATZ+VM+COB) combination and the nivolumab and ipilimumab (NIVO+IPI) combination for the treatment of BRAF-confirmed metastatic melanoma in adult patients.

Materials and methods. With the help of mathematical modeling methods, a pharmacoeconomic “cost-effectiveness” ana- lysis; a “budget impact” analysis; a sensitivity analysis to the changes in the initial parameters of the model, were carried out.

Results. The analysis of literature sources made it possible to conclude that the combination of ATZ+VM+COB compared with the combination of NIVO+IPI (15.1 and 11.2 months, respectively) has a greater clinical efficacy in terms of a progression-free survival (PFS) in patients with metastatic melanoma. When choosing the ATZ+VM+COB combination, the total cost of treatment for one adult patient with metastatic melanoma per course was lower, compared to the NIVO+IPI combination (RUB 8 326 864.89 vs RUB 7 172 751.68); the difference amounted to 1 154 113.21 rubles. When calculating the “cost-effectiveness” ratio for a year of a progression-free survival, the advantage of the ATZ + VM + COB combination in comparison with the NIVO + IPI combination, remained (5 700 200.01 rubles vs 8 942 400.10 rubles); the difference amounted to 3 242 200.09 rubles. The sensitivity analysis demonstrated the developed model stability to an increase in the cost of the ATZ + VM + COB course up to + 16%, a decrease in the cost of the NIVO + IPI course to –13%, and a reduction in the PFS to –37% against the background of the ATZ + VM + COB course. The “budget impact” analysis showed the possibility of reducing costs by 8 655 849.11 rubles with an increase from 5% to 20% in the proportion of the patients administrated with the ATZ+VM+COB combination, and with a decrease from 95% to 80% in the proportion of the patients administrated with the NIVO+IPI combination.

Conclusion. The results of the work have shown that within the healthcare system of the Russian Federation, the triple combination of ATZ+VM+COB is a clinically cost-effective option for the treatment of adult metastatic melanoma patients with a confirmed BRAF mutation.

About the authors

Ivan S. Krysanov

Moscow State University of Food Production; LLC “Institute of Clinical and Economic Expertise and Pharmacoeconomics”; A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: krysanov-ivan@mail.ru
ORCID iD: 0000-0002-3541-1120

Candidate of Sciences (Pharmacy), Associate Professor, Head of the Pharmacy Course of the Medical Institute of Continuing Education of Moscow State University of Food Production; Head of the Department of Clinical and Economic Analysis of the Institute of Clinical and Economic Expertise and Pharmacoeconomics; Head of the Research Laboratory of Pharmacy, Pharmacology, Pharmacognosy, Pharmaceutical Technology and Chemistry, A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, 11, Volokolamsk Hwy, Moscow, 125080; Bld. 6, 21, Novomytishchinsky Ave., Mytishchi, Moscow region, 141008; Bld. 1, 20, Delegatskaya Str., Moscow, 127473

Ekaterina V. Makarova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry; National Research Institute of Public Health named after N.A. Semashko

Email: rue-royal@inbox.ru
ORCID iD: 0000-0003-3767-8475

Candidate of Sciences (Medicine), Senior Researcher, National Research Institute of Public Health n.a. NA Semashko; Researcher of the Research Laboratory of Pharmacy, Pharmacology, Pharmacognosy, Pharmaceutical Technology and Che- mistry, A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Russian Federation, Bld. 1, 20, Delegatskaya Str., Moscow, 127473; Bld. 1, 12, Vorontsovo Pole Str., Moscow, 105064

Victoria Y. Ermakova

LLC “Institute of Clinical and Economic Expertise and Pharmacoeconomics”; Sechenov First Moscow State Medical University

Email: ermakova.viktoriya.yurievna@mail.ru
ORCID iD: 0000-0002-4822-7226

Candidate of Sciences (Pharmacy), Executive Director of the Institute of Clinical and Economic Expertise and Pharmacoeconomics; Associate Professor of the Department of Chemistry, Sechenov First Moscow State Medical University

Russian Federation, Bld. 6, 21, Novomytishchinsky Ave., Mytishchi, Moscow region, 141008; Bld. 4, 2, Bolshaya Pirogovskaya Str., Moscow, 119435

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2. Figure 1 - Savings when using a combination of ATZ + VM + COB

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3. Figure 1 – Savings in administration of ATZ + VM + COB combination

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Copyright (c) 2022 Krysanov I.S., Makarova E.V., Ermakova V.Y.

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