OBJECTIVES: Currently there are no official guidelines for the treatment of advanced melanoma in the Brazilian Public Healthcare System, and the therapy drug most commonly prescribed is dacarbazine (DTIC). The objective of this study is to evaluate the cost-effectiveness of therapies approved for advanced melanoma in Brazil

METHODS: A cost-effectiveness model was developed to estimate accrued life years and direct medical costs over a lifetime horizon (30 years) for the population with advanced melanoma regardless BRAF status attended by Brazilian Public Healthcare System. The three-state model employs a partitioned survival analysis approach in which progression and survival are modeled separately. The therapies considered in this analysis were: NIVO, ipilimumab (IPI), pembrolizumab (PEMBRO) and dacarbazine (DTIC). DTIC was selected as comparator because it is the most prescribed therapy in the Public Healthcare System. This analysis considered only AEs graded 3 and 4, of which frequencies were derived from the clinical trials of each comparator in the systematic literature review. Administration, adverse events and procedures costs were estimated using a micro-costing approach and prices were obtained from official Brazilian price lists. The ICER for each therapy was calculated versus DTIC.

RESULTS: The Incremental Survival, in years, for each therapy were: NIVO: 3.28; PEMBRO: 2.43; IPI: 1.42. The ICER for each therapy were: NIVO: $21,862; PEMBRO: $25,336; IPI: $35,896. The NIVO ICER was lower than the threshold of 3 times the Brazilian Gross Domestic Product per capita ($ 25,002.90).

CONCLUSIONS: Longer survival associated with NIVO combined with the incremental costs, resulted in an ICER indicating that it is likely to be a cost-effective option in the first line treatment of patients with advanced melanoma regardless BRAF status. These data suggest that a better allocation of resources for the treatment of this population in the Brazilian Public Healthcare System may be warranted.