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For End-of-Life Metastatic Melanoma, Dabrafenib Has Value
At a strict willingness-to-pay threshold of ≤$100,000/quality-adjusted life-year, the chemotherapeutic alkylating agent dacarbazine is the optimal treatment for patients with metastatic melanoma who have the BRAFV600E mutation, according to a study in the online Journal of Skin Cancer.
However, at a willingness-to-pay threshold of ≥$150,000/quality-adjusted life-year, or if the overall cost was cut to $30,000 to $31,000, the optimal treatment is the BRAF inhibitor dabrafenib. Dabrafenib had an effectiveness of 0.3385 quality-adjusted life-years, researchers found, compared with the dacarbazine’s 0.1820 quality-adjusted life-years.
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“Although our incremental cost-effectiveness ratio for dabrafenib compared to dacarbazine is not cost-effective at that price under the traditional willingness-to-pay threshold, as an end-of-life treatment for a disease state with few options, there is evidence to suggest that, at negotiated prices within specific health plans, it is within acceptable limits to US payers and can be recommended as a treatment option with value,” researchers wrote.
The study is the first to gauge the economic value of the relatively new targeted therapies dabrafenib and vemurafenib with dacarbazine for patients with BRAFV600E metastatic melanoma. Researchers looked at 2 clinical trials involving more than 900 patients in Australia, Europe, and North America to arrive at their findings.
In terms of cost and effectiveness, dabrafenib dominated the BRAF inhibitor vemurafenib, which had an effectiveness of 0.2905 quality-adjusted life-years. Dabrafenib was 8 times more expensive than dacarbazine, while vemurafenib was 10 times more expensive.—Jolynn Tumolo
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