Journal of Clinical Oncology, Vol 15, 2351-2358, Copyright © 1997 by American Society of Clinical Oncology

ARTICLES

Economic analysis of adjuvant interferon alfa-2b in high-risk melanoma based on projections from Eastern Cooperative Oncology Group 1684

BE Hillner, JM Kirkwood, MB Atkins, ER Johnson and TJ Smith
Department of Internal Medicine and the Massey Cancer Center, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298, USA. hillner@gems.vcu.edu

PURPOSE: Interferon alfa-2b (IFN) in a randomized clinical trial (E1684) prolonged relapse-free and total survival in high-risk resected melanoma. However, the costs and toxicities of IFN are barriers to its widespread use. This study was undertaken to analyze the projected costs and long-term benefits of IFN by combining prospectively collected data on IFN actual dosage, time of recurrence, and survival with secondary data on long-term melanoma recurrence risks to project the cost-effectiveness of adjuvant IFN compared with observation. PATIENTS AND METHODS: Two hypothetical cohorts of 50-year-old melanoma patients whose mean IFN dosage and clinical results were directly taken from E1684 were included in the study. Melanoma recurrence risks beyond 5 years were derived from international databases. Melanoma recurrence care costs and quality-of-life adjustments, when considered, were based on expert consensus. End points were incremental costs, life-years gained, and cost per life-year gained with and without quality-of-life adjustments. RESULTS: The IFN cohort was projected to have an increased (undiscounted) survival of 0.52 years at 7 years and 1.90 years over a lifetime. The projected incremental cost (in 1996 United States dollars) per life-year gained in the IFN cohort ranged from $13,700 after 35 years to $32,600 at 7 years, the median follow-up of E1684. Using assigned quality-of-life values for IFN and recurrence, the lifetime cost per quality adjusted life-year increased to $15,200. Even if treatment costs for recurrence were excluded, the lifetime incremental cost per life-year gained was $21,600. CONCLUSION: The cost and toxicity of IFN must be balanced against its projected benefits in high-risk melanoma. The derived cost-effectiveness and cost-utility ratios for IFN were comparable to other cancer interventions for which cost-effectiveness analysis has been performed.

This article has been cited by other articles:

				J. N. Cormier, Y. Xing, M. Ding, S. B. Cantor, K. J. Salter, J. E. Lee, P. F. Mansfield, J. E. Gershenwald, and M. I. Ross Cost Effectiveness of Adjuvant Interferon in Node-Positive Melanoma J. Clin. Oncol., June 10, 2007; 25(17): 2442 - 2448. [Abstract] [Full Text] [PDF]

				R. Ng, B. Hasan, N. Mittmann, M. Florescu, F. A. Shepherd, K. Ding, C. A. Butts, Y. Cormier, G. Darling, G. D. Goss, et al. Economic Analysis of NCIC CTG JBR.10: A Randomized Trial of Adjuvant Vinorelbine Plus Cisplatin Compared With Observation in Early Stage Non-Small-Cell Lung Cancer--A Report of the Working Group on Economic Analysis, and the Lung Disease Site Group, National Cancer Institute of Canada Clinical Trials Group J. Clin. Oncol., June 1, 2007; 25(16): 2256 - 2261. [Abstract] [Full Text] [PDF]

				H. Tsao, M. B. Atkins, and A. J. Sober Management of Cutaneous Melanoma N. Engl. J. Med., September 2, 2004; 351(10): 998 - 1012. [Full Text] [PDF]

				E. C. Schneider, A. M. Epstein, J. L. Malin, K. L. Kahn, and E. J. Emanuel Developing a System to Assess the Quality of Cancer Care: ASCO's National Initiative on Cancer Care Quality J. Clin. Oncol., August 1, 2004; 22(15): 2985 - 2991. [Full Text] [PDF]

				G. A. Porter, S. B. Cantor, G. L. Walsh, V. W. Rusch, D. H. Leung, A. Y. DeJesus, R. E. Pollock, M. F. Brennan, and P. W. T. Pisters Cost-effectiveness of pulmonary resection and systemic chemotherapy in the management of metastatic soft tissue sarcoma: A combined analysis from the University of Texas M. D. Anderson and Memorial Sloan-Kettering Cancer Centers J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1366 - 1372. [Abstract] [Full Text] [PDF]

				B.W. Hancock, K. Wheatley, S. Harris, N. Ives, G. Harrison, J.M. Horsman, M.R. Middleton, N. Thatcher, P.C. Lorigan, J.R. Marsden, et al. Adjuvant Interferon in High-Risk Melanoma: The AIM HIGH Study--United Kingdom Coordinating Committee on Cancer Research Randomized Study of Adjuvant Low-Dose Extended-Duration Interferon Alfa-2a in High-Risk Resected Malignant Melanoma J. Clin. Oncol., January 1, 2004; 22(1): 53 - 61. [Abstract] [Full Text] [PDF]

				M. S. Sabel and V. K. Sondak Pros and Cons of Adjuvant Interferon in the Treatment of Melanoma Oncologist, October 1, 2003; 8(5): 451 - 458. [Abstract] [Full Text] [PDF]

				R. F. Kefford Adjuvant therapy of cutaneous melanoma: the interferon debate Ann. Onc., March 1, 2003; 14(3): 358 - 365. [Abstract] [Full Text] [PDF]

				C. Garbe, A. Paul, H. Kohler-Spath, U. Ellwanger, W. Stroebel, M. Schwarz, B. Schlagenhauff, F. Meier, B. Schittek, H.-J. Blaheta, et al. Prospective Evaluation of a Follow-Up Schedule in Cutaneous Melanoma Patients: Recommendations for an Effective Follow-Up Strategy J. Clin. Oncol., February 1, 2003; 21(3): 520 - 529. [Abstract] [Full Text] [PDF]

				C. C. Earle, R. H. Chapman, C. S. Baker, C. M. Bell, P. W. Stone, E. A. Sandberg, and P. J. Neumann Systematic Overview of Cost-Utility Assessments in Oncology J. Clin. Oncol., September 18, 2000; 18(18): 3302 - 3317. [Abstract] [Full Text] [PDF]

				J. M. Kirkwood, J. G. Ibrahim, V. K. Sondak, J. Richards, L. E. Flaherty, M. S. Ernstoff, T. J. Smith, U. Rao, M. Steele, and R. H. Blum High- and Low-Dose Interferon Alfa-2b in High-Risk Melanoma: First Analysis of Intergroup Trial E1690/S9111/C9190 J. Clin. Oncol., June 12, 2000; 18(12): 2444 - 2458. [Abstract] [Full Text] [PDF]

				B. E. Hillner, S. Agarwala, and M. R. Middleton Post Hoc Economic Analysis of Temozolomide Versus Dacarbazine in the Treatment of Advanced Metastatic Melanoma J. Clin. Oncol., April 7, 2000; 18(7): 1474 - 1480. [Abstract] [Full Text] [PDF]

				Integrating Economic Analysis Into Cancer Clinical Trials: the National Cancer Institute-American Society of Clinical Oncology Economics Workbook J Natl Cancer Inst Monographs, August 1, 1998; 1998(24): 1 - 28. [Full Text]