OBJECTIVES

Among neoplasms in adults, melanoma is one of the most fatal and most likely to undergo cerebral metastasis, despite it represents only 3% of malignant skin neoplasms. Melanoma is associated with important clinical, humanistic and economic impacts, resulting in loss of life years, loss of quality of life, and important expenses, which increase with the disease progression. Recently, the therapeutic arsenal has evolved considerably, with several new effective options being available. Due to this, there is a need to evaluate which are the best options from the clinical and economic points of view. The aim of this study was to compare the cost per response of dabrafenib and trametinib with immunotherapies (IO) for the treatment of metastatic or unresectable BRAF V600-mutant melanoma patients.

METHODS

The clinical outcome evaluated was the objective response rate (ORR, 95% confidence intervals) as reported in the longer follow-up of the respective randomized clinical trial. These rates were 68% for dabrafenib combined with trametinib, 58% for nivolumab plus ipilimumab, 42,9% for nivolumab and 36% for pembrolizumab. The annual costs of the treatments were calculated considering the label posology, assuming an average of weight of 70Kg. The treatments price were based on the factory CMED 2019 list. The cost per objective response was obtained dividing the annual cost of treatment by the respective ORR.

RESULTS

The annual cost per objective response for dabrafenib + trametinibe was the lowest when compared with all IO alternatives, estimated in BRL 7,350 per response. The estimated cost per response was BRL 9,170 for nivolumab + ipilimumab, BRL 7,777 for nivolumab and BRL 8,341 for pembrolizumab.

CONCLUSIONS

Considering the BRAF V600 mutation population and response rate as outcome, dabrafenib + trametinib are the target therapy that is most effective when compared to IO and presented the lowest cost per response among all the options.