A cost-effectiveness analysis of trametinib plus dabrafenib as first-line therapy for metastatic BRAF V600-mutated melanoma in the Swiss setting

Abstract

Background: The treatment of patients with metastatic melanomas that harbour BRAF V600E or V600K mutations with trametinib plus dabrafenib appears to be superior to treatment with vemurafenib alone. This treatment regimen is likely to become available in Switzerland in the near future. Objectives: To determine the cost-effectiveness of trametinib plus dabrafenib. Methods: A Markov cohort simulation was conducted to model the clinical course of typical patients with metastatic melanoma. Information on response rates, clinical condition and follow-up treatments were derived and transition probabilities estimated based on the results of a clinical trial that compared treatment with trametinib plus dabrafenib vs. vemurafenib alone. Results: Treatment with trametinib plus dabrafenib was estimated to cost an additional CHF199 647 (Swiss francs) on average and yield a gain of 0·52 qualityadjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio of CHF385 603 per QALY. Probabilistic sensitivity analyses showed that a willingness-to-pay threshold of CHF100 000 per QALY would not be reached at the current US price of trametinib. Conclusions: The introduction of trametinib in Switzerland at US market prices for the treatment of metastatic BRAF V600-mutated melanoma with trametinib plus dabrafenib is unlikely to be cost-effective compared with vemurafenib monotherapy. A reduction in the total price of the combination therapy is required to achieve an acceptable cost-effectiveness ratio for this clinically promising treatment. Accepted ArticleThis article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/bjd.14152 This article is protected by copyright. All rights reserved. What is known about this topic?• Several new promising treatments for patients with metastatic melanoma that harbour BRAF V600E or V600K mutations have recently become available • Trametinib is not yet available in Switzerland, but approval is expected in 2015 • These new treatments are very expensive Accepted ArticleThis article is protected by copyright. All rights reserved. What does this study add?• Although clinically promising, at current US trametinib prices, trametinib plus dabrafenib will not be cost effective compared to vemurafenib in the Swiss setting • Only a reduction in the price of the combination therapy would make this therapy cost effective AbstractBackground and Objective: The treatment of patients with metastatic melanomas that harbour BRAF

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