Using pembrolizumab every 3 weeks followed by second-line ipilumumab was found to be the most cost-effective immune-based treatment strategy in patients with treatment-naive BRAF wild-type advanced melanoma, according to a recent study. First-line nivolumab followed by second-line ipilumumab was also seen as cost-effective.

Investigators developed Markov models testing several treatment options. They defined health states for initial treatment, first and second progression, and death, and used phase 3 trial data to determine the likelihood of transition between states. Among the results:

• Pembrolizumab every 3 weeks followed by second-line ipilumumab was both more effective and less costly than dacarbazine followed by ipilumumab then nivolumab, or ipilumumab followed by nivolumab.
• Compared with the first-line dacarbazine, nivolumab followed by ipilumumab produced an incremental cost effectiveness ratio of ~$91,000/QALY.
• First-line nivolumab + ipilumumab followed by carboplatin plus paclitaxel chemotherapy produced an incremental cost effectiveness ratio of ~$199,000/QALY.