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Relative Clinical Value in Advanced Cancer Treatments

2013; Elsevier BV; Volume: 16; Issue: 7 Linguagem: Inglês

10.1016/j.jval.2013.08.2020

1524-4733

M.C. Preto, Rosângela Monteiro, Carolina Sampieri Santinho, Geraldo Bernardino, B.M.K. Donato, Lorella Fanti, Stephen Stefani,

Health Systems, Economic Evaluations, Quality of Life

To evaluate clinical and economic value of ipilimumab in the treatment of advanced melanoma compared with drugs available for the treatment of advanced cancer. An analysis was performed comparing ipilimumab and other drugs for advanced cancer regarding overall survival (OS) and costs associated with improvement in survival. Parameters analyzed were: improvement in median/mean OS, improvement on survival rate at 1 year and the number needed to treat (NNT) to avoid one death. Monthly costs for improvement in mean OS were evaluated. Efficacy data were obtained from clinical trials. Medications costs were obtained from official price lists, such as Banco de Dados de Preços do Sistema de Saúde do Ministério da Saúde Brasileiro and Lista da Câmara de Regulação do Mercado de Medicamentos da Agência Nacional de Vigilância Sanitária (CMED). Improvement in median OS ranged from +2.8 (sorafenib) to +4.8 (transtuzumab), and improvements in mean OS ranged from +1.6 (sorafenib) to +6.1 (ipilimumab). Only ipilimumab showed better mean OS compared with the median OS (6.1 vs. 3.7). This demonstrates the effect of ipilimumab in prolonging OS in long term, which is observed in a considerable proportion of patients treated with this drug. Major improvement in the survival rate in 1 year occurred with ipilimumab (20%). The NNT to prevent 1 death ranged from 7 (ipilimumab) to 61 (bevacizumab for lung cancer). Costs per month of mean OS improvement ranged from BRL 34,906 (sorafenib) to BRL 64,410 (bevacizumab for lung cancer). This comparative analysis of drugs used for treatment of advanced cancer used key parameters for decision making in health sciences. The results suggest that ipilimumab delivers superior clinical and economic benefits when compared with other drugs available in Brazil for the treatment of advanced cancer.