This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cormier, J. N. Articles by Ross, M. I. Search for Related Content PubMed PubMed Citation Articles by Cormier, J. N. Articles by Ross, M. I.

Cost Effectiveness of Adjuvant Interferon in Node-Positive Melanoma

Janice N. Cormier, Yan Xing, Meichun Ding, Scott B. Cantor, Kristi J. Salter, Jeffrey E. Lee, Paul F. Mansfield, Jeffrey E. Gershenwald, Merrick I. Ross

From the Departments of Surgical Oncology and Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX; and Amgen Inc, Thousand Oaks, CA

Address reprint requests to Janice N. Cormier, MD, MPH, Department of Surgical Oncology, Unit 444, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, PO Box 301402, Houston, TX 77230-1402; e-mail: jcormier{at}mdanderson.org

Purpose: To assess the benefits of adjuvant high-dose interferon alfa (HDI) treatment for patients with high-risk melanoma.

Methods: We designed a decision-analytic probabilistic Markov model to simulate the natural history of patients with stage IIIA, IIIB, and IIIC melanoma and evaluate the outcomes with and without HDI treatment. Outcomes were in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Probability estimates and costs were derived from primary patient level data, while the efficacy of HDI and associated utilities were determined from published reports. The base-case analysis was a cohort of 50-year-old patients.

Results: HDI increased the median life expectancy in patients with stage III melanoma from 3.75 years in the observation cohort to 4.42 years in the HDI cohort. The difference in QALYs ranged from 0.31 years for stage IIIA patients to 0.60 years for stage IIIC patients treated with HDI. HDI was cost effective in patients with stage IIIB and IIIC melanoma, with ICERs of $95,304 and $76,068 per QALY gained, respectively. Using a threshold of $100,000 per QALY gained, HDI was cost effective for all stage III patients younger than 52 years. HDI was not cost effective for patients with stage IIIA disease and for subsets of patients older than 63 years with stage IIIB disease.

Conclusion: Our model demonstrates that the probability of HDI being cost effective varies substantially by melanoma substage. HDI showed the greatest benefit in terms of QALYs and was most cost effective in patients younger than 60 years with stage IIIC disease.

Supported in part by an American Society of Clinical Oncology Career Development Award, and National Cancer Institute, Clinical Oncology Research Development Program, 5-K12-CA088084.

Presented in part in the Expert Review of Pharmacoeconomics Outcomes Research and at the Society of Medical Decision Making, October 18-22, 2003, Chicago, IL; and the International Society of Pharmacoeconomics and Outcomes Research, May 18-21, 2004, Arlington, VA.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.