Double Immune Checkpoint Inhibition as First-Line Treatment for BRAF-Mutant Advanced Melanoma: A Cost-Effectiveness Analysis from the Brazilian Private Healthcare System Perspective
Author(s)
Rodrigo Pereira, D.Sc.1, Milton Barros, M.Sc.2, Gisele Marinho dos Santos, MBA3, Camila Finardi Roubik, B.Pharm.4, Thais Herrero Geraldino, D.Sc.4, Leandro Ladislau Alves, D.Sc.4.
1Grupo Oncoclínicas, Porto Alegre, Brazil, 2A.C. Camargo Cancer Center, Sao Paulo, Brazil, 3Americas Oncologia, São Paulo, Brazil, 4Bristol Myers Squibb, Sao Paulo, Brazil.
1Grupo Oncoclínicas, Porto Alegre, Brazil, 2A.C. Camargo Cancer Center, Sao Paulo, Brazil, 3Americas Oncologia, São Paulo, Brazil, 4Bristol Myers Squibb, Sao Paulo, Brazil.
OBJECTIVES: Recent evidence about sequencing suggests that initiating treatment with dual immunotherapy offers significant clinical benefits for patients with BRAFV600-mutant advanced melanoma. These findings have prompted updates to melanoma guidelines. In resource-limited settings, evaluating the economic implications of clinical practices is essential. Thus, this analysis assessed the cost-effectiveness of starting with nivolumab/ipilimumab followed by dabrafenib/trametinib versus the reverse sequence for advanced melanoma with BRAF mutation.
METHODS: A partitioned survival model with three health states was developed from the Brazilian private healthcare system perspective. The target population comprised adult patients with advanced melanoma with BRAF mutation. The model projected overall survival (OS) and progression-free survival (PFS) to estimate drug and follow-up costs over a lifetime horizon of up to 39 years (average age at diagnosis: 61 years). Clinical data were sourced from the Phase 3 DREAMseq Trial (ECOG-ACRIN EA6134). The primary outcome was the incremental cost-utility ratio (ICUR), expressed as cost per quality-adjusted life year (QALY) and life-year (LY) gained. Costs, reported in Brazilian real (BRL), included drug acquisition, follow up and adverse event management, calculated using a microcosting approach and discounted at an annual rate of 5%. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: The base-case analysis showed cost savings of 165,400 BRL with the treatment sequence initiating with nivolumab/ipilimumab followed by dabrafenib/trametinib. Additionally, an incremental gain of 2.69 life-years (LY) and 2.26 quality-adjusted life years (QALY) were estimated by using this proposed strategy versus initial treatment with drabrafenib/trametinib. Therefore the results with initial dual immunotherapy was considered dominant (superior outcome at a lower cost).
CONCLUSIONS: First line nivolumab/ipilimumab followed by dabrafenib/trametinib proved to be a cost-effective strategy for managing BRAF-mutant advance melanoma, dominating the reverse sequence from the Brazilian private healthcare perspective. This economic evaluation reinforces the clinical benefit and efficient use of resources of initiating treatment with this dual immunotherapy.
METHODS: A partitioned survival model with three health states was developed from the Brazilian private healthcare system perspective. The target population comprised adult patients with advanced melanoma with BRAF mutation. The model projected overall survival (OS) and progression-free survival (PFS) to estimate drug and follow-up costs over a lifetime horizon of up to 39 years (average age at diagnosis: 61 years). Clinical data were sourced from the Phase 3 DREAMseq Trial (ECOG-ACRIN EA6134). The primary outcome was the incremental cost-utility ratio (ICUR), expressed as cost per quality-adjusted life year (QALY) and life-year (LY) gained. Costs, reported in Brazilian real (BRL), included drug acquisition, follow up and adverse event management, calculated using a microcosting approach and discounted at an annual rate of 5%. Deterministic and probabilistic sensitivity analyses were performed.
RESULTS: The base-case analysis showed cost savings of 165,400 BRL with the treatment sequence initiating with nivolumab/ipilimumab followed by dabrafenib/trametinib. Additionally, an incremental gain of 2.69 life-years (LY) and 2.26 quality-adjusted life years (QALY) were estimated by using this proposed strategy versus initial treatment with drabrafenib/trametinib. Therefore the results with initial dual immunotherapy was considered dominant (superior outcome at a lower cost).
CONCLUSIONS: First line nivolumab/ipilimumab followed by dabrafenib/trametinib proved to be a cost-effective strategy for managing BRAF-mutant advance melanoma, dominating the reverse sequence from the Brazilian private healthcare perspective. This economic evaluation reinforces the clinical benefit and efficient use of resources of initiating treatment with this dual immunotherapy.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE439
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology