For patients with advanced melanoma, response-adapted treatment de-escalation is cost-effective and offers an incremental net monetary benefit of $28,849 versus standard of care, according to a study published online Oct. 19 in JAMA Dermatology .

Zachary Cartun, M.D., from University Hospital, LMU Munich in Germany, and colleagues conducted a cost-effectiveness analysis using data from the ADAPT-IT and CheckMate 067 trials as well as published literature to determine the cost-effectiveness of ipilimumab discontinuation for patients with interim imaging-confirmed tumor response in advanced melanoma treatment. A total of 355 patients with previously untreated melanoma were included in the analysis: 41 from the ADAPT-IT trial and 314 from the CheckMate 067 trial.

The researchers found that in 94.0 percent of scenarios, response-adapted treatment was the cost-effective option based on Monte Carlo simulations, with a dominant incremental cost-effectiveness ratio and an incremental net monetary benefit of $28,849 versus standard of care. The estimated cost savings were $19,891 per patient compared with standard of care. Current standard of care was only considered as a cost-effective option under best survival assumptions in scenario analyses and if the willingness-to-pay threshold exceeded $630,000/quality-adjusted life year.

"Response-adapted de-escalation of immunotherapy, as proposed by the ADAPT-IT trial, has the potential to alleviate the financial burden for patients with advanced melanoma," the authors write. "We hope that this study can inform future trial design to identify novel and more affordable treatment strategies."

Several authors disclosed ties to the pharmaceutical industry.

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