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A cost‐effectiveness analysis of trametinib plus dabrafenib as first‐line therapy for metastatic BRAF V600‐mutated melanoma in the Swiss setting
Author(s) -
MatterWalstra K.,
Braun R.,
Kolb C.,
Ademi Z.,
Dummer R.,
Pestalozzi B.C.,
Schwenkglenks M.
Publication year - 2015
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.14152
Subject(s) - dabrafenib , trametinib , vemurafenib , medicine , oncology , melanoma , clinical trial , metastatic melanoma , cancer research , biology , mapk/erk pathway , kinase , microbiology and biotechnology
Summary 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 CHF 199 647 (Swiss francs) on average and yield a gain of 0·52 quality‐adjusted life years ( QALY s), resulting in an incremental cost‐effectiveness ratio of CHF 385 603 per QALY . Probabilistic sensitivity analyses showed that a willingness‐to‐pay threshold of CHF 100 000 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.