Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis
Purpose. Two BRAFV600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAFV600E patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Journal of Skin Cancer |
| Online Access: | http://dx.doi.org/10.1155/2015/505302 |
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| author | Vanessa Shih Renske M. ten Ham Christine T. Bui Dan N. Tran Jie Ting Leslie Wilson |
| author_facet | Vanessa Shih Renske M. ten Ham Christine T. Bui Dan N. Tran Jie Ting Leslie Wilson |
| author_sort | Vanessa Shih |
| collection | DOAJ |
| description | Purpose. Two BRAFV600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAFV600E patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000–$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed. |
| format | Article |
| id | doaj-art-2d95dc1ebddc48648a864a0d14430e31 |
| institution | Kabale University |
| issn | 2090-2905 2090-2913 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Skin Cancer |
| spelling | doaj-art-2d95dc1ebddc48648a864a0d14430e312025-02-03T01:09:10ZengWileyJournal of Skin Cancer2090-29052090-29132015-01-01201510.1155/2015/505302505302Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness AnalysisVanessa Shih0Renske M. ten Ham1Christine T. Bui2Dan N. Tran3Jie Ting4Leslie Wilson5Department of Clinical Pharmacy, University of California, San Francisco, 3333 California Street, Laurel Heights, San Francisco, CA 94143, USADepartment of Clinical Pharmacy, University of California, San Francisco, 3333 California Street, Laurel Heights, San Francisco, CA 94143, USADepartment of Clinical Pharmacy, University of California, San Francisco, 3333 California Street, Laurel Heights, San Francisco, CA 94143, USADepartment of Clinical Pharmacy, University of California, San Francisco, 3333 California Street, Laurel Heights, San Francisco, CA 94143, USADepartment of Clinical Pharmacy, University of California, San Francisco, 3333 California Street, Laurel Heights, San Francisco, CA 94143, USADepartment of Clinical Pharmacy, University of California, San Francisco, 3333 California Street, Laurel Heights, San Francisco, CA 94143, USAPurpose. Two BRAFV600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAFV600E patients, a mutation that affects ~50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ~85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of $100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000–$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed.http://dx.doi.org/10.1155/2015/505302 |
| spellingShingle | Vanessa Shih Renske M. ten Ham Christine T. Bui Dan N. Tran Jie Ting Leslie Wilson Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis Journal of Skin Cancer |
| title | Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis |
| title_full | Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis |
| title_fullStr | Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis |
| title_full_unstemmed | Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis |
| title_short | Targeted Therapies Compared to Dacarbazine for Treatment of BRAFV600E Metastatic Melanoma: A Cost-Effectiveness Analysis |
| title_sort | targeted therapies compared to dacarbazine for treatment of brafv600e metastatic melanoma a cost effectiveness analysis |
| url | http://dx.doi.org/10.1155/2015/505302 |
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