Abstract
BACKGROUND: Recent studies have shown the efficacy of perioperative immunotherapy in improving the event-free survival of patients with advanced resectable melanoma. This study evaluated the cost-effectiveness of different perioperative immunotherapy treatment strategies versus adjuvant immunotherapy treatment strategies from the US payer perspective. METHODS: Two immunotherapy strategies were each compared with the corresponding standard adjuvant treatment in two Markov models: Model (1) perioperative nivolumab plus ipilimumab versus adjuvant nivolumab for stage III patients; model (2) perioperative pembrolizumab versus adjuvant pembrolizumab for stage IIIB to IVC patients. Primary outcomes included direct costs, life-year gained (LYG), quality-adjusted life-year (QALY), and incremental cost per QALY (ICER). Sensitivity analyses were conducted to evaluate the robustness of the model outcomes. RESULTS: In base-case analysis, perioperative nivolumab plus ipilimumab (versus adjuvant nivolumab) gained higher QALY (by 2.73) with cost-saving (by USD109,157) in model (1), and perioperative pembrolizumab (versus adjuvant pembrolizumab) gained higher QALY (by 2.29) with cost-saving (by USD130,157) in model (2). Both perioperative strategies were accepted as cost-effective. One-way sensitivity analyses found the base-case results robust to variation in all model parameters at willingness-to-pay threshold of 100,000 USD/QALY. Probabilistic sensitivity analysis demonstrated that the two perioperative strategies were accepted as cost-effective in 100% of 10,000 simulations. CONCLUSIONS: Perioperative immunotherapies demonstrated cost-saving compared with adjuvant immunotherapies from the US payer perspective. One-way and probabilistic sensitivity analyses supported the robustness of the cost-effectiveness results. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14258-y.