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Cost-Effectiveness of Treatment Strategies for BRAF-Mutated Metastatic Melanoma

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  • Patti Curl
  • Igor Vujic
  • Laura J van ‘t Veer
  • Susana Ortiz-Urda
  • James G Kahn

Abstract

Purpose: Genetically-targeted therapies are both promising and costly advances in the field of oncology. Several treatments for metastatic melanoma with a mutation in the BRAF gene have been approved. They extend life but are more expensive than the previous standard of care (dacarbazine). Vemurafenib, the first drug in this class, costs $13,000 per month ($207,000 for a patient with median survival). Patients failing vemurafenib are often given ipilimumab, an immunomodulator, at $150,000 per course. Assessment of cost-effectiveness is a valuable tool to help navigate the transition toward targeted cancer therapy. Methods: We performed a cost-utility analysis to compare three strategies for patients with BRAF+ metastatic melanoma using a deterministic expected-value decision tree model to calculate the present value of lifetime costs and quality-adjusted life years (QALYs) for each strategy. We performed sensitivity analyses on all variables. Results: In the base case, the incremental cost-effectiveness ratio (ICER) for vemurafenib compared with dacarbazine was $353,993 per QALY gained (0.42 QALYs added, $156,831 added). The ICER for vemurafenib followed by ipilimumab compared with vemurafenib alone was $158,139. In sensitivity analysis, treatment cost had the largest influence on results: the ICER for vemurafenib versus dacarbazine dropped to $100,000 per QALY gained with a treatment cost of $3600 per month. Conclusion: The cost per QALY gained for treatment of BRAF+ metastatic melanoma with vemurafenib alone or in combination exceeds widely-cited thresholds for cost-effectiveness. These strategies may become cost-effective with lower drug prices or confirmation of a durable response without continued treatment.

Suggested Citation

  • Patti Curl & Igor Vujic & Laura J van ‘t Veer & Susana Ortiz-Urda & James G Kahn, 2014. "Cost-Effectiveness of Treatment Strategies for BRAF-Mutated Metastatic Melanoma," PLOS ONE, Public Library of Science, vol. 9(9), pages 1-9, September.
    • Handle: RePEc:plo:pone00:0107255
    DOI: 10.1371/journal.pone.0107255
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