Cost–Utility of Adjuvant High-Dose Interferon Alpha Therapy in Stage III Cutaneous Melanoma in Quebec

• Published in: Value in health Vol. 7; no. 4; pp. 423 - 432
• Main Authors: Crott, R., Ali, F., Burdette-Radoux, S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK and Malden, USA Elsevier Inc 01.07.2004; Blackwell Science Inc
• Subjects: Adult; Algorithms; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - economics; Chemotherapy, Adjuvant; Clinical Trials as Topic; Cohort Studies; Computer Simulation; Cost of Illness; Cost-Benefit Analysis; cost–utility; Disease-Free Survival; economics; Follow-Up Studies; Health Status; Humans; interferon; Interferon-alpha - administration & dosage; Interferon-alpha - economics; Markov Chains; melanoma; Melanoma - drug therapy; Melanoma - economics; Melanoma - mortality; Middle Aged; Monte Carlo Method; Neoplasm Recurrence, Local - economics; Quality of Life; Quebec; Risk; Skin Neoplasms - drug therapy; Skin Neoplasms - economics; Skin Neoplasms - mortality; Software; Survival Analysis; Terminal Care - economics; Time Factors; Quebec; melanoma; cost–utility; economics; interferon
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1111/j.1524-4733.2004.74005.x

To estimate the cost–utility of adjuvant high-dose interferon in high-risk melanoma patients in Quebec compared to a watchful waiting strategy. A Markov model was developed that replicates the findings of the pivotal E1684 trial. It was then used to extrapolate survival over a period of 35 years. Costs of medical resources used during the first year were derived through a detailed analysis of a sample (n = 13) of patients treated in a leading academic hospital. Follow-up costs were assessed through a medical decision algorithm. Utilities were derived from a population-based survey (n = 104) in different locations in Quebec using the time trade-off method. The mean incremental cost per quality-adjusted life-year of adjuvant Interferon therapy is equal to CAN$55,090 over a follow-up of 7 years but drops down to CAN$14,003 when extrapolated over 35 years. Estimates of the cost-effectiveness of high-dose interferon in melanoma patients show an acceptable cost-effectiveness ratio if long-term survival is taken into account. Estimates are, however, strongly influenced by the observed trial differences in survival, the utility associated to health states, and the discount rate.