Cost-effectiveness of treatment strategies for BRAF-mutated metastatic melanoma.

Cost-effectiveness of treatment strategies for BRAF-mutated metastatic melanoma.

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PURPOSE:Genetically-targeted therapies are both promising and costly advances in the sten jacket m field of oncology.Several treatments for metastatic melanoma with a mutation in the BRAF gene have been approved.They extend life but are more expensive than the previous standard of care (dacarbazine).Vemurafenib, the first drug in this class, costs $13,000 per month ($207,000 for a patient with median survival).

Patients failing vemurafenib are often given ipilimumab, an immunomodulator, at $150,000 per course.Assessment of cost-effectiveness is a valuable tool to help navigate the transition toward targeted cancer therapy.METHODS:We performed a cost-utility analysis to compare three strategies for patients with BRAF+ metastatic melanoma using a deterministic expected-value decision tree model to calculate the present value of lifetime costs and quality-adjusted life years (QALYs) for whelen arges spotlight each strategy.We performed sensitivity analyses on all variables.

RESULTS:In the base case, the incremental cost-effectiveness ratio (ICER) for vemurafenib compared with dacarbazine was $353,993 per QALY gained (0.42 QALYs added, $156,831 added).The ICER for vemurafenib followed by ipilimumab compared with vemurafenib alone was $158,139.In sensitivity analysis, treatment cost had the largest influence on results: the ICER for vemurafenib versus dacarbazine dropped to $100,000 per QALY gained with a treatment cost of $3600 per month.

CONCLUSION:The cost per QALY gained for treatment of BRAF+ metastatic melanoma with vemurafenib alone or in combination exceeds widely-cited thresholds for cost-effectiveness.These strategies may become cost-effective with lower drug prices or confirmation of a durable response without continued treatment.