Cost-Effectiveness of Adjuvant Therapy Among Medicare Patients With BRAF-Mutant Melanoma

Findings from a recent study suggest that dabrafenib–trametinib may offer incremental quality-adjusted life years (QALYs) in patients with BRAF-mutant stage III melanoma, but it is not considered cost-effective (Ann Surg Oncol. 2021. doi:10.1245/s10434-021-10288-4).

While patient survival is improved with adjuvant therapy among patients with stage III melanoma, its cost-effectiveness must be analyzed in order to be considered as a treatment option among the Medicare patient population.

This study aimed to examine the cost-effectiveness of 4 recently approved adjuvant therapies for the treatment of BRAF-mutant stage III melanoma in the Medicare patient population.

Saam Mojtahed, BS, Pritzker School of Medicine, Division of Biological Sciences, University of Chicago, Chicago, IL, and colleagues constructed a Markov microsimulation model, simulating the health care trajectory of patients receiving either first-line targeted therapy or immunotherapy.

A 65-year-old Medicare patient with BRAF V600E-mutant resected stage III melanoma acted as the base case for this study. Authors used published clinical trials to determine transition probabilities, and CMS-reported reimbursement rates and the Red Book drug price database to determine costs. Costs, life years, QALYs, and incremental cost-effectiveness ratios (ICERs) were the primary outcomes in this study.

When compared with no treatment, dabrafenib–trametinib provided 1.83 additional QALYs, with an ICER of $95,758 per QALY. When compared with the most effective immunotherapy, pembrolizumab, dabrafenib–trametinib provided 0.23 additional QALYs, with an ICER of 285,863 per QALY. Pembrolizumab dominated other immunotherapies, and, when compared with no treatment, had an ICER of $68,396 per QALY.

“Pembrolizumab is cost-effective at a conventional willingness-to-pay (WTP) threshold, but dabrafenib–trametinib is not,” concluded Dr Mojtahed and colleagues, 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