OBJECTIVES: Sonidegib was approved recently in the US and EU to treat locally advanced basal cell carcinomas (laBCCs) ineligible for curative surgery or radiotherapy. Vismodegib is the other approved targeted oral therapy for advanced BCC. Both treatments were approved on the basis of single arm trial data (sonidegib: BOLT [Migden et al., 2015]; vismodegib: ERIVANCE [Sekulic et al., 2012]). Their comparative effectiveness was demonstrated via a matching-adjusted indirect comparison (MAIC) (Odom et al., 2016), conducted to adjust for trial differences in baseline patient characteristics. The MAIC confirmed the findings from a naïve indirect comparison, showing longer progression free survival (PFS) and a greater objective response rate for sonidegib versus vismodegib. Our objective was to examine the cost-effectiveness, from a United Kingdom (UK) payer perspective, of sonidegib versus vismodegib for adults with laBCC not amenable to surgery or radiotherapy.
METHODS: A partitioned-survival model (PFS, progressive disease, death) was developed, with PFS further partitioned by time spent with response versus stable disease. Estimates of OS were from the UK general population (mean age 63 years). Utility weights were from the literature (Shingler et al., 2013). Costs included drugs (assuming price parity per pill for sonidegib and vismodegib), adverse event monitoring and treatment, physician visits, and wound care. A 10 year horizon was employed. The model estimated expected costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). A discount rate of 3.5% was applied to costs and QALYs.
RESULTS: Expected total costs (discounted) for sonidegib and vismodegib were £146,362 and £167,423, respectively. Expected LYs (undiscounted) were 9.43 for both comparators. Expected QALYs (discounted) for sonidegib and vismodegib were 5.10 and 4.98, respectively.
CONCLUSIONS: In comparison to vismodegib, sonidegib is expected to improve QALYs and reduce costs (i.e., is dominant). Sensitivity analyses demonstrated that the results were robust to parameter uncertainty and variability.
