Cost-Effectiveness of Adjuvant Therapies for BRAF-Mutant Melanoma

Findings from an analysis of recently approved adjuvant therapies for BRAF-mutant stage III melanoma suggest that pembrolizumab is most cost-effective at a conventional willingness-to-pay (WTP) threshold (Ann Surg Oncol. 2021. doi:10.1245/s10434-021-10288-4).      

“Adjuvant therapy for stage III melanoma improves several measures of patient survival,” explained Saam A Mojtahed, BS, Pritzker School of Medicine, Division of Biological Sciences, University of Chicago, IL, and colleagues, adding “however, decisions regarding inclusion of adjuvant therapies in the formularies of public payers necessarily consider the cost-effectiveness of those treatments.”

This led Dr Mojtahed and colleagues to conduct this analysis evaluating the cost-effectiveness of four recently approved adjuvant therapies for BRAF-mutant stage III melanoma among the Medicare patient population.

A Markov microsimulation model was constructed to simulate the healthcare trajectory of patients receiving either first-line targeted therapy (dabrafenib–trametinib) or immunotherapy (ipilimumab, nivolumab, or pembrolizumab).

A 65-year-old Medicare patient with BRAF V600E-mutant resected stage III melanoma acted as the base case for this study. Recurrence-free survival, adverse events, local recurrence, distant metastases, and death were some of the possible health states.

Transition probabilities were derived from published clinical trials, and costs were derived from reimbursement rates reported by CMS and the Red Book drug price database. Life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs), and costs were the primary outcomes.  

When compared to no treatment, dabrafenib–trametinib added 1.83 QALYs, and had an ICER of $95,758 per QALY.  When compared to pembrolizumab, dabrafenib–trametinib added 0.23 QALYs, and had an ICER of $285,863 per QALY.

Results suggested that pembrolizumab was the more cost-effective immunotherapy in this study, and when compared with no treatment, had an ICER of $68,396/QALY.

“Pembrolizumab is cost-effective at a conventional WTP threshold, but dabrafenib–trametinib is not,” concluded the authors, adding, “though dabrafenib–trametinib offers incremental QALYs, optimization of drug pricing is necessary to ensure dabrafenib–trametinib is accessible at an acceptable WTP threshold.—Marta Rybczynski