OBJECTIVES: The aim of the study was to conduct a pharmacoeconomic evaluation of the atezolizumab, vemurofenib and cobimetinib (ATZ+VM+COB) combination and the nivolumab and ipilimumab (NIVO+IPI) combination for the treatment of BRAF-confirmed metastatic melanoma in adult patients.

METHODS: By means of mathematical modeling a pharmacoeconomic cost-effectiveness analysis (CEA); a budget impact analysis (BIA); a sensitivity analysis to the changes in the initial parameters of the model, were carried out.

RESULTS: The analysis of literature showed that the ATZ+VM+COB, compared to the NIVO+IPI, has a greater clinical efficacy in terms of a progression-free surveillance (PFS) - 15.1 and 11.2 months, respectively in patients with metastatic melanoma. The cost of ATZ+VM+COB per course for was lower compared to the NIVO+IPI (€92 520,72 vs €79 697,24 and €12 823,48 difference. CEA showed an advantage of ATZ+VM+COB compared IVO+IPI combination. The cost-effectiveness ratios (CERs) for a year PFS were €63 335,56 and €99 360,00, retrospetively, €36 024,45. difference. The sensitivity analysis demonstrated the stability of the developed model to an increase in the ATZ+VM+COB cost up to +16%, a decrease in the NIVO+IPI cost up to -13%, and a reduction in the PFS up to -37% during ATZ+VM+COB treatment. The BIA showed possibility of reducing budget expences by €96 176,10 with an increase in the proportion of the patients treated by the ATZ+VM+COB from 5% to 20%, with simultaneous decrease in the proportion of the patients treated by NIVO+IPI from 95% to 80%.

CONCLUSIONS: The triple combination of ATZ+VM+COB is a clinically cost-effective option for the treatment of adult metastatic melanoma patients with a confirmed BRAF mutation.