{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:04:24Z","timestamp":1779289464468,"version":"3.51.4"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T00:00:00Z","timestamp":1680220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["151290"],"award-info":[{"award-number":["151290"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012118","name":"Ontario Institute for Cancer Research","doi-asserted-by":"publisher","award":["#IA\u2010035"],"award-info":[{"award-number":["#IA\u2010035"]}],"id":[{"id":"10.13039\/100012118","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The efficacy\u2010effectiveness gap between randomized trial and real\u2010world evidence regarding the clinical benefit of ipilimumab for metastatic melanoma (MM) has been well characterized by previous literature, consistent with initial concerns raised by health technology assessment agencies (HTAs). As these differences can significantly impact cost\u2010effectiveness, it is critical to assess the real\u2010world cost\u2010effectiveness of second\u2010line ipilimumab versus non\u2010ipilimumab treatments for MM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a population\u2010based retrospective cohort study of patients who received second\u2010line non\u2010ipilimumab therapies between 2008 and 2012 versus ipilimumab treatment between 2012 and 2015 (after public reimbursement) for MM in Ontario. Using a 5\u2010year time horizon, censor\u2010adjusted and discounted (1.5%) costs (from the public payer's perspective in Canadian dollars) and effectiveness were used to calculate incremental cost\u2010effectiveness ratios (ICERs) in life\u2010years gained (LYGs) and quality\u2010adjusted life years (QALYs), with bootstrapping to capture uncertainty. Varying the discount rate and reducing the price of ipilimumab were done as sensitivity analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 329\u2009MM were identified (Treated: 189; Controls: 140). Ipilimumab was associated with an incremental effectiveness of 0.59 LYG, incremental cost of $91,233, and ICER of $153,778\/LYG. ICERs were not sensitive to discounting rate. Adjusting for quality of life using utility weights resulted in an ICER of $225,885\/QALY, confirming the original HTA estimate prior to public reimbursement. Reducing the price of ipilimumab by 100% resulted in an ICER of $111,728\/QALY.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite its clinical benefit, ipilimumab as second\u2010line monotherapy for MM patients is not cost\u2010effective in the real world as projected by HTA under conventional willingness\u2010to\u2010pay thresholds.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.5862","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T13:37:52Z","timestamp":1680269872000},"page":"11451-11461","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost\u2010effectiveness of second\u2010line ipilimumab for metastatic melanoma: A real\u2010world population\u2010based cohort study of resource utilization"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-0862","authenticated-orcid":false,"given":"Brandon","family":"Lu","sequence":"first","affiliation":[{"name":"Sunnybrook Health Sciences Centre  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei Fang","family":"Dai","sequence":"additional","affiliation":[{"name":"Canadian Centre for Applied Research in Cancer Control  Toronto Ontario Canada"},{"name":"Ontario Health (Cancer Care Ontario)  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Croxford","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanrudee","family":"Isaranuwatchai","sequence":"additional","affiliation":[{"name":"Canadian Centre for Applied Research in Cancer Control  Toronto Ontario Canada"},{"name":"St Michael's Hospital  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaclyn","family":"Beca","sequence":"additional","affiliation":[{"name":"Canadian Centre for Applied Research in Cancer Control  Toronto Ontario Canada"},{"name":"Ontario Health (Cancer Care Ontario)  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ines B.","family":"Menjak","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre  Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa M.","family":"Petrella","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Mittmann","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre  Toronto Ontario Canada"},{"name":"University of Toronto  Toronto Ontario Canada"},{"name":"Canadian Agency for Drugs and Technologies in Health  Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig C.","family":"Earle","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Gavura","sequence":"additional","affiliation":[{"name":"Ontario Health (Cancer Care Ontario)  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca E.","family":"Mercer","sequence":"additional","affiliation":[{"name":"Canadian Centre for Applied Research in Cancer Control  Toronto Ontario Canada"},{"name":"Ontario Health (Cancer Care Ontario)  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy P.","family":"Hanna","sequence":"additional","affiliation":[{"name":"Division of Cancer Care and Epidemiology Queen's University Cancer Research Institute  Kingston Ontario Canada"},{"name":"Department of Oncology Queen's University  Kingston Ontario Canada"},{"name":"ICES, Queen's University  Kingston Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2501-3057","authenticated-orcid":false,"given":"Kelvin K. 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