Cost-Effectiveness of Vemurafenib Vs Ipilimumab Plus Dacarbacine in the Treatment of Non-Resectable Metastasic Melanoma with Braf600e Mutation in Colombia

Abstract

OBJECTIVES: To evaluate the cost-effectiveness of vemurafenib compared with ipilimumab plus dacarbacine for the treatment of patients with metastasic melanoma BRAF600E mutation in the Colombian context. METHODS: A cost-effectiveness analysis using a Markov model was conducted adopting the perspective of a third party payer (Colombian health care system). Time horizon was 12 months, with monthly cycles. Three health states were considered, progression free survival (PFS), disease progression (DP), and death. This model assessed three primary outcomes: Quality Adjusted Life Years (QALYs), PFS and overall survival (OS). Transition probabilities and utilities were obtained from published randomized clinical trials and literature, respectively. Direct costs included were estimated from official national databases (in November 2014 Colombian pesos, exchange rate used 1 USD= 2140 COP). Adverse events were also included with a similar presentation among the two health states. RESULTS: For the 12-month time horizon, there were 0.089 incremental life years gained and 0.099 QALYs with vemurafenib. Ipilimumab plus dacarbacine was dominated by vemurafenib for the three primary outcomes. The total cost per patient was USD 63,936 for vemurafenib, USD 126,936 for ipilimumab plus dacarbacine (incremental cost USD 63,000). CONCLUSIONS: Compared with ipilimumab plus dacarbacine, vemurafenib is cost-saving and is associated with better clinical outcomes in the Colombian context.