Abstract:
Importance:A phase 2 trial comparing talimogene laherparepvec plus ipilimumab vs ipilimumab monotherapy in patients with advanced unresectable melanoma found no differential benefit in progression-free survival (PFS) but noted objective response rates (ORRs) of 38.8% (38 of 98 patients) vs 18.0% (18 of 100 patients), respectively. Objective:To perform an economic evaluation of talimogene laherparepvec plus ipilimumab combination therapy vs ipilimumab monotherapy. Design, Setting, and Participants:For PFS, cost-effectiveness and cost-utility analyses using a 2-state Markov model (PFS vs progression or death) was performed. For ORRs, cost-effectiveness analysis of the incremental cost of 1 additional patient achieving objective response was performed. In this setting based on a US payer perspective (2017 US dollars), participants were patients with advanced unresectable melanoma. Main Outcomes and Measures:The PFS life-years and PFS quality-adjusted life-years were determined, and the associated incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were estimated. Also estimated was the ICER per 1 additional patient (out of 100 treated patients) achieving objective response. Base-case analyses were validated by sensitivity analyses. Results:In PFS analyses, the cost of talimogene laherparepvec plus ipilimumab ($494 983) exceeded the cost of ipilimumab monotherapy ($132 950) by $362 033. The ICER was $2 129 606 per PFS life-years, and the ICUR was $2 262 706 per PFS quality-adjusted life-year gained. Probabilistic sensitivity analyses yielded an ICER of $1 481 208 per PFS life-year gained and an ICUR of $1 683 191 per PFS quality-adjusted life-year gained. In 1-way sensitivity analyses, the PFS hazard ratio and the utility of response were the most influential parameters. Talimogene laherparepvec plus ipilimumab has a 50% likelihood of being cost-effective at a willingness-to-pay threshold of $1 683 191 per PFS quality-adjusted life-year gained. In ORR analyses, talimogene laherparepvec plus ipilimumab ($474 904) vs ipilimumab alone ($132 810), a $342 094 difference, yielded an ICER of $1 629 019 per additional patient achieving objective response. In subgroup analyses by disease stage and BRAFV600E mutation status, ICERs ranged from $1 069 044 to $17 104 700 per 1 additional patient achieving objective response. Conclusions and Relevance:The cost to gain 1 additional progression-free quality-adjusted life-year, 1 additional progression-free life-year, or to have 1 additional patient attain objective response is about $1.6 million. This amount may be beyond what payers typically are willing to pay. Combination therapy of talimogene laherparepvec plus ipilimumab does not offer an economically beneficial treatment option relative to ipilimumab monotherapy at the population level. This should not preclude treatment for individual patients for whom this regimen may be indicated.
journal_name
JAMA Dermatoljournal_title
JAMA dermatologyauthors
Almutairi AR,Alkhatib NS,Oh M,Curiel-Lewandrowski C,Babiker HM,Cranmer LD,McBride A,Abraham Idoi
10.1001/jamadermatol.2018.3958subject
Has Abstractpub_date
2019-01-01 00:00:00pages
22-28issue
1eissn
2168-6068issn
2168-6084pii
2715092journal_volume
155pub_type
杂志文章,多中心研究,随机对照试验相关文献
JAMA Dermatology文献大全abstract:Importance:There is limited information regarding the influence of patient demographics, tumor characteristics, and treatment type on the survival of patients with dermatofibrosarcoma protuberans (DFSP). Objective:To assess prognostic factors and to evaluate the influence of treatment modality on overall survival of p...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2016.1886
更新日期:2016-12-01 00:00:00
abstract:IMPORTANCE:Worse survival among patients with melanoma has been demonstrated in middle-aged and older men compared with women, but few studies have explored survival differences by sex in adolescents and young adults, in whom melanoma is the third most common cancer. Focusing on sex disparities in survival among younge...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2013.4408
更新日期:2013-08-01 00:00:00
abstract:IMPORTANCE:Topical corticosteroids are the current first-line therapy for vulvar lichen sclerosus (VLS). UV-A1 phototherapy may be a promising alternative treatment option, but controlled studies are lacking. OBJECTIVE:To compare the efficacy of high-potent topical corticosteroids with UV-A1 phototherapy in the treatm...
journal_title:JAMA dermatology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamadermatol.2013.7733
更新日期:2014-06-01 00:00:00
abstract:IMPORTANCE:Nevi are among the strongest risk factors for melanoma. However, little is known about the association of many total nevi (TN) or atypical nevi (AN) with tumor thickness. OBJECTIVES:To examine the association between age and the number of TN and AN and to explore whether there was a relationship between TN ...
journal_title:JAMA dermatology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamadermatol.2016.0027
更新日期:2016-04-01 00:00:00
abstract:Importance:The differential diagnosis between proliferative nodules (PNs) and melanoma arising in congenital melanocytic nevi (CMN) is crucial, as patients with PNs most often experience no increased risk of melanoma with metastases and death. Objective:To analyze the utility of immunohistochemistry and fluorescence i...
journal_title:JAMA dermatology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamadermatol.2016.2667
更新日期:2016-10-01 00:00:00
abstract:Importance:Atopic dermatitis (AD) and allergic contact dermatitis (ACD) have a dynamic relationship not yet fully understood. Investigation has been limited thus far by a paucity of data on the overlap of these disorders in pediatric patients. Objective:To use data from the Pediatric Contact Dermatitis Registry to elu...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2016.6136
更新日期:2017-08-01 00:00:00
abstract:Importance:Incidence rates of skin cancer are increasing globally, and the correct classification of skin lesions (SLs) into benign and malignant tissue remains a continuous challenge. A collective intelligence approach to skin cancer detection may improve accuracy. Objective:To evaluate the performance of 2 well-know...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2015.3149
更新日期:2015-12-01 00:00:00
abstract:Importance:Patients with vascular malformations (VAMs) and vascular overgrowth syndromes have lower health-related quality of life (HRQoL) attributable to social stigmatization, poor mental health, severity, and pain. However, the factors that contribute to this decreased HRQoL are not clear. Objective:To perform a sy...
journal_title:JAMA dermatology
pub_type: 杂志文章,meta分析
doi:10.1001/jamadermatol.2018.0002
更新日期:2018-06-01 00:00:00
abstract:Importance:There is ongoing controversy about the adverse events of finasteride, a drug used in the management of alopecia and benign prostatic hyperplasia (BPH). In 2012, reports started emerging on men who had used finasteride and either attempted or completed suicide. Objective:To investigate the association of sui...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2020.3385
更新日期:2021-01-01 00:00:00
abstract:Importance:The dupilumab regimen of 300 mg every 2 weeks is approved for uncontrolled, moderate to severe atopic dermatitis (AD). Objective:To assess the efficacy and safety of different dupilumab regimens in maintaining response after 16 weeks of initial treatment. Design, Setting, and Participants:The Study to Conf...
journal_title:JAMA dermatology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamadermatol.2019.3617
更新日期:2020-02-01 00:00:00
abstract:IMPORTANCE:Basal cell carcinomas (BCCs) are diagnosed by clinical evaluation, which can include dermoscopic evaluation, biopsy, and histopathologic examination. Recent translation of multiphoton microscopy (MPM) to clinical practice raises the possibility of noninvasive, label-free in vivo imaging of BCCs that could re...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2015.0453
更新日期:2015-10-01 00:00:00
abstract:Importance:Although regression is commonly observed in cutaneous melanoma, it is uncertain whether it is associated with patient prognosis. Objective:To determine whether histologically confirmed regression was associated with better or worse survival in patients with primary cutaneous melanoma. Design, Setting, and ...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2020.5032
更新日期:2020-12-23 00:00:00
abstract:Importance:Psoriasis of the scalp, palms and/or soles, and nails is challenging to treat. Objective:To evaluate the effect of guselkumab on psoriasis in specific body regions. Design, Setting, and Participants:VOYAGE 1 and VOYAGE 2 were, double-blind, placebo- and adalimumab-controlled studies of guselkumab conducted...
journal_title:JAMA dermatology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamadermatol.2018.0793
更新日期:2018-06-01 00:00:00
abstract:IMPORTANCE:Approximately 10% to 25% of patients treated with BRAF inhibitors develop cutaneous squamous cell carcinoma (SCC), but the mechanism responsible has not yet been determined. We report what we believe to be the first case in which Merkel cell polyomavirus (MCPyV) and human papillomavirus subtype 17 (HPV-17) w...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2013.2023
更新日期:2013-03-01 00:00:00
abstract:IMPORTANCE:Psoriasis and atopic dermatitis (AD) are inflammatory diseases thought to be mediated by helper T-cell subtypes 1 and 2 (TH1 and TH2), respectively. Although psoriasis and AD show histopathologic differences during chronic disease, they are difficult to distinguish histologically during erythrodermic exacerb...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2015.2
更新日期:2015-07-01 00:00:00
abstract:Importance:Necrobiotic xanthogranuloma (NXG) is a non-Langerhans cell histiocytosis classically associated with paraproteinemia attributable to plasma-cell dyscrasias or lymphoproliferative disorders. Despite the morbidity of NXG, the literature is limited to case reports and small studies, and diagnostic criteria are ...
journal_title:JAMA dermatology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamadermatol.2019.4221
更新日期:2020-03-01 00:00:00
abstract:Importance:Sun-protective behavior affects skin cancer prevention. Shade works by physically shielding skin from direct harmful UV rays; however, skin may still remain exposed to reflected and indirect UV rays. There is no current standard metric to evaluate shade for its effectiveness in sun protection, and there is i...
journal_title:JAMA dermatology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamadermatol.2016.4922
更新日期:2017-03-01 00:00:00
abstract:IMPORTANCE:Recent data demonstrated somatic mutations in GJB2 that were present in affected porokeratotic eccrine ostial and dermal duct nevus (PEODDN) tissue but absent in unaffected skin. Recognizing that PEODDN lesions can also appear in individuals with keratitis-ichthyosis-deafness syndrome and finding somatic mut...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2014.5069
更新日期:2015-06-01 00:00:00
abstract:Importance:High-cost biologic therapies have transformed the management of immune-mediated inflammatory diseases. To optimize outcomes and reduce costs, dose adjustment informed by measurement of circulating drug levels has been shown to be effective in various settings. However, limited evidence exists for this approa...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2019.1783
更新日期:2019-09-18 00:00:00
abstract:Importance:Hemophagocytic lymphohistiocytosis (HLH) has been reported as a serious complication of cutaneous T-cell lymphoma (CTCL). Despite available diagnostic guidelines, it remains a diagnostic and therapeutic challenge in this patient population. Objectives:To examine the characteristics of CTCL associated with H...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2018.1264
更新日期:2018-07-01 00:00:00
abstract:Importance:Use of systemic therapies for moderate to severe psoriasis in children is increasing, but comparative data on their use and toxicities are limited. Objective:To assess patterns of use and relative risks of systemic agents for moderate to severe psoriasis in children. Design, Setting, and Participants:A ret...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2017.3029
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:To compare the prevalence and incidence of type 2 diabetes mellitus between patients with psoriasis and those without psoriasis. DATA SOURCES:MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews between January 1, 1980, and January 1, 2012. STUDY SELECTION:Observational (cohort, case-control, and cr...
journal_title:JAMA dermatology
pub_type: 杂志文章,meta分析,评审
doi:10.1001/2013.jamadermatol.406
更新日期:2013-01-01 00:00:00
abstract:IMPORTANCE:Treatment outcomes depend on adherence to the prescribed regimen. Primary nonadherence refers to not obtaining and starting to take a prescribed medication. The frequency of primary nonadherence to acne treatment has not been well characterized. The complexity of multidrug acne regimens may add to this probl...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2014.5254
更新日期:2015-06-01 00:00:00
abstract:Importance:Advanced practice professionals (APPs) such as nurse practitioners and physician assistants independently perform a large number and variety of dermatologic procedures, but little is known about how the number and scope of these procedures have changed over time. Objective:To examine the trends in scope and...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2018.1768
更新日期:2018-09-01 00:00:00
abstract:IMPORTANCE:Solid-organ transplant recipients (OTRs) are at an increased risk for skin cancer. Prior studies have demonstrated a reduced incidence of skin cancer in renal OTRs treated with sirolimus. However, little information exists on the use of sirolimus for the prevention of skin cancer in nonrenal OTRs or those al...
journal_title:JAMA dermatology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamadermatol.2015.5548
更新日期:2016-05-01 00:00:00
abstract:IMPORTANCE:Mobile smartphones are rapidly emerging as an effective means of communicating with many Americans. Using mobile applications (apps), they can access remote databases, track time and location, and integrate user input to provide tailored health information. OBJECTIVE:A smartphone mobile app providing person...
journal_title:JAMA dermatology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamadermatol.2014.3889
更新日期:2015-05-01 00:00:00
abstract:Importance:Melanoma treatment has been revolutionized with the development of immune-based therapies that offer durable clinical responses in a subset of patients. Clinical outcomes after treatment by immunotherapy can be influenced by the host's immune system. The immune system is modified with age by age-related immu...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2017.4584
更新日期:2018-01-01 00:00:00
abstract:IMPORTANCE:Evidence-based treatment guidelines are not available for primary cutaneous mucinous carcinoma (PCMC). OBJECTIVE:To assess outcomes associated with surgical treatment of PCMC. DATA SOURCES:MEDLINE, Cumulative Index to Nursing and Allied Health, and Embase from 1952 to 2010. Search terms were "primary cutan...
journal_title:JAMA dermatology
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamadermatol.2013.6006
更新日期:2014-04-01 00:00:00
abstract:Importance:Controversy persists regarding the appropriate management of incompletely excised, biopsy-proven, mild and moderate dysplastic nevi (DN). Objective:To determine long-term risk of associated melanoma in biopsied mild or moderate DN with positive histologic margins that were clinically observed vs reexcised w...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2016.2869
更新日期:2016-12-01 00:00:00
abstract:Importance:Population-level disease metrics are critical to guide the distribution of resources and implementation of public health initiatives. Internet search data reflect population interest in health topics and may be an alternative metric of disease characteristics when traditional sources are lacking, such as in ...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2017.1870
更新日期:2017-09-01 00:00:00