Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France - CRLC Val d'Aurelle - Paul Lamarque Access content directly
Journal Articles Current Oncology Year : 2022

Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France

1 IGR - Institut Gustave Roussy
2 U1018 (Équipe 2) - Oncostat
3 SBE - Service de biostatistique et d'épidémiologie
4 Centre Léon Bérard [Lyon]
5 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
6 Service de Dermatologie [AP-HP Hôpital Saint-Louis]
7 HIPI (UMR_S_976 / U976) - Immunologie humaine, physiopathologie & immunothérapie
8 ONCO-THAI - Thérapies Laser Assistées par l'Image pour l'Oncologie - U 1189
9 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]
10 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
11 UM - Université de Montpellier
12 CHU de Bordeaux - Centre Hospitalier Universitaire de Bordeaux
13 CHU - Centre Hospitalier Universitaire [Grenoble]
14 Service de Dermatologie (CHU de Dijon)
15 CHU Nice - Centre Hospitalier Universitaire de Nice
16 Hôpital Ambroise Paré [AP-HP]
17 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
18 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
19 CHU Amiens-Picardie
20 Hôpital Haut-Lévêque [CHU Bordeaux]
21 Hôpital Avicenne [AP-HP]
22 CRLCC - Centre Eugène Marquis
23 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
24 TIMONE - Hôpital de la Timone [CHU - APHM]
25 Service de Dermatologie et Allergologie [CHRU Nancy]
26 CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes]
27 IRCM - U1194 Inserm - UM - Institut de Recherche en Cancérologie de Montpellier
28 CHU Pontchaillou [Rennes]
29 CHU Nantes - Centre hospitalier universitaire de Nantes
30 GRADES - Groupe de Recherche et d'Accueil en Droit et Economie de la Santé
Sophie Dalac
Philippe Saiag
Jean-Philippe Arnault
  • Function : Author
  • PersonId : 1101821
Julie De Quatrebarbes
  • Function : Author
Marie Beylot-Barry
Ève Maubec
  • Function : Author
  • PersonId : 1101819
Thierry Lesimple
Jean-Jacques Grob
Alain Dupuy
  • Function : Author
  • PersonId : 937572


Nine drugs have been marketed for 10 years for the treatment of advanced melanoma (AM). With half of patients reaching a second line, the optimal sequence of treatments remains unclear. To inform policy-makers about their efficiency, we performed a cost-effectiveness analysis of sequential strategies in clinical practice in France, for BRAF-mutated and wild-type patients. A multistate model was developed to describe treatment sequences, associated costs, and health outcomes over 10 years. Sequences, clinical outcomes, utility scores, and economic data were extracted from the prospective Melbase cohort, collecting individual data in 1518 patients since 2013, from their AM diagnosis until their death. To adjust the differences in patients’ characteristics among sequences, weighting by inverse probability was used. In the BRAF-mutated population, the MONO-targeted therapies (TT)-anti-PD1 sequence was the less expensive, whereas the anti-PD1-BI-TT sequence had an incremental cost-effectiveness ratio (ICER) of 180,441 EUR/QALY. Regarding the BRAF wild-type population, the three sequences constituted the cost-effective frontier, with ICERs ranging from 116 to 806,000 EUR/QALY. For BRAF-mutated patients, the sequence anti-PD1-BI-TT appeared to be the most efficient one in BRAF-mutated AM patients until 2018. Regarding the BRAF wild-type population until 2018, the sequence starting with IPI+NIVO appeared inefficient compared to anti-PD1, considering the extra cost for the QALY gained.
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Dates and versions

hal-04049403 , version 1 (28-03-2023)





Marguerite Kandel, Aurélie Bardet, Stéphane Dalle, Clara Allayous, Laurent Mortier, et al.. Cost-Effectiveness Analysis of Sequential Treatment Strategies for Advanced Melanoma in Real Life in France. Current Oncology, 2022, 29 (12), pp.9255-9270. ⟨10.3390/curroncol29120725⟩. ⟨hal-04049403⟩
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