OBJECTIVES: To estimate the cost-utility of early BRAF mutation testing (along with the diagnosis of melanoma) compared to late BRAF mutation testing (only in patients who progress) for election of adjuvant treatment with dabrafenib+trametinib (for BRAF+ cases) or immunotherapy (for BRAF- cases), in adult patients with stage III melanoma surgically resected and with high risk of recurrence, from the perspective of the Colombian health system.

METHODS: A partitioned survival model with states of recurrence-free survival, post-recurrence survival and death was developed with a 5-year time horizon. Direct medical costs for medicines and their administration, handling of adverse events, surgery, monitoring and palliative care were included. The sources of costs were: ISS tariff, SISMED, price control circulars, and the databases of RIPS and sufficiency (1 USD = 3,477 COP, year 2020). The survival and adverse events data were based on clinical trials, network meta-analysis and economic evaluations. Utility values were extracted from the literature. A 5% discount rate was applied for health outcomes and costs. Health effects were calculated as Quality Adjusted Life Years (QALYs). Probabilistic sensitivity analysis were conducted with Monte Carlo simulations.

RESULTS: In the base case, average values per patient are: USD$ 228,779/2.95 QALYs for early BRAF mutation testing and USD$ 263,737/2.92 QALYs for late BRAF mutation testing. The early BRAF mutation testing is a dominant alternative (ΔCost = USD$ -34,958 and ΔQALYs = 0.03). Probabilistic sensitivity analysis reports a 100% probability of early BRAF mutation testing being a cost-effective strategy for a willingness-to-pay threshold of three times GDP per capita. The results aren’t sensitive to changes in model parameters.

CONCLUSIONS: Early BRAF mutation testing is a cost-effective and cost-saving alternative to the Colombian health system, as a tool for election of adjuvant treatment in adult patients with stage III melanoma surgically resected and high risk of recurrence.