Cost Utility of Target Therapies Compared to Dacarbazine for First-Line Treatment of Advanced Non-Surgical and Metastatic Melanoma in the Brazilian National Health System
Cost Utility of Target Therapies Compared to Dacarbazine for First-Line Treatment of Advanced Non-Surgical and Metastatic Melanoma in the Brazilian National Health System
Data
2019
Autores
Guerra, Renata Leborato
Corrêa, Flavia de Miranda
Fernandes, Ricardo Ribeiro Alves
Zimmerman, Ivan Ricardo
Journal Title
Journal ISSN
Volume Title
Publisher
Value in Health Regional Issues
Resumo
Objetivo: Estimar a razao de custo-utilidade incremental (RCUI) de esquemas de terapias-alvo isoladas e combinadas em comparação a dacarbazina para o tratamento de primeira linha do melanoma avançado não-cirúrgico e metastático com mutação no gene BRAF V600.
Métodos: Um modelo de Markov com três estados de saúde (sem progressão, progressão e morte), ciclo de duração mensal e horizonte temporal de 10 anos foi construído para comparar terapias-alvo
(vemurafenibe, dabrafenibe, vemurafenibe/cobimetinibe e dabrafenibe/trametinibe) com a quimioterapia com dacarbazina, sob a perspectiva do
Sistema Único de Saúde (SUS). Analises de sensibilidade determinística univariada e probabilıística foram realizadas. Resultados: O custo médio das terapias foi R$5.662,50 para dacarbazina, R$175.937,18 para vemurafenibe, R$167.461,70 para dabrafenibe, R$425.901,00 para vemurafenibe/cobimetinibe e R$411.799,81 para dabrafenibe/trametinibe. O QALY foi
estimado em 0,91 para dacarbazina, 1,08 para vemurafenibe, 1,12 para dabrafenibe, 1,64 para vemurafenibe/cobimetinibe e 1,56 para dabrafe-
nibe/trametinibe. A RCUI variou desde R$572.165,76 a R$1.012.524,56 por paciente, e os parâmetros com maior impacto no resultado foram risco de progressão e morte e custo do tratamento. Conclusão: A incorporação das terapias-alvo no SUS produziria um gasto adicional de pelo menos 19 vezes o PIB per capita nacional para aumentar em um ano a sobrevida ajustada por qualidade de cada paciente com melanoma
avançado/metastatico BRAF-mutante.
Objective: To estimate the incremental cost-utility ratio (ICUR) of isolated and combined targeted therapy regimens compared to dacarbazine for first-line treatment of advanced and metastatic mel- anoma with BRAF V600 mutation. Methods: A Markov model with three health states (no progression, progression and death), monthly duration cycle and 10-year time horizon was constructed to compare targeted therapy regimens (vemurafenib, dabrafenib, vemurafenib/ cobimetinib and dabrafenib/trametinib) with dacarbazine chemo- therapy under the Brazilian public health perspective. One-way and probabilistic sensitivity analyses were performed. Results: Mean cost was R$5662.50 ($1490.13) for dacarbazine, R$175 937.18 (46 299.26) for vemurafenib, R$167 461.70 ($44 068.87) for dabrafenib, R$425 901 ($112 079.21) for vemurafenib/cobimetinib and R$411 799.81 ($108 368.37) for dabrafenib/trametinib, whereas QALY was 0.91 for dacarbazine, 1.08 for vemurafenib, 1.12 for dabrafenib, 1.64 for vemurafenib/cobimetinib and 1.56 for dabrafenib/trametinib. The ICUR was estimated from R$572 165.76 ($150 569.94) to R$1 012 524.56 ($266 453.83) per patient, and the most impactful parameters were risk of progression and death, and treatment cost. Conclusion: The incorporation of targeted therapies in the Brazilian public health system would produce an additional expenditure of at least 19 times the national GDP per capita to increase in one year the quality-adjusted survival of each patient with advanced/ metastatic BRAF-mutant melanoma.
Objective: To estimate the incremental cost-utility ratio (ICUR) of isolated and combined targeted therapy regimens compared to dacarbazine for first-line treatment of advanced and metastatic mel- anoma with BRAF V600 mutation. Methods: A Markov model with three health states (no progression, progression and death), monthly duration cycle and 10-year time horizon was constructed to compare targeted therapy regimens (vemurafenib, dabrafenib, vemurafenib/ cobimetinib and dabrafenib/trametinib) with dacarbazine chemo- therapy under the Brazilian public health perspective. One-way and probabilistic sensitivity analyses were performed. Results: Mean cost was R$5662.50 ($1490.13) for dacarbazine, R$175 937.18 (46 299.26) for vemurafenib, R$167 461.70 ($44 068.87) for dabrafenib, R$425 901 ($112 079.21) for vemurafenib/cobimetinib and R$411 799.81 ($108 368.37) for dabrafenib/trametinib, whereas QALY was 0.91 for dacarbazine, 1.08 for vemurafenib, 1.12 for dabrafenib, 1.64 for vemurafenib/cobimetinib and 1.56 for dabrafenib/trametinib. The ICUR was estimated from R$572 165.76 ($150 569.94) to R$1 012 524.56 ($266 453.83) per patient, and the most impactful parameters were risk of progression and death, and treatment cost. Conclusion: The incorporation of targeted therapies in the Brazilian public health system would produce an additional expenditure of at least 19 times the national GDP per capita to increase in one year the quality-adjusted survival of each patient with advanced/ metastatic BRAF-mutant melanoma.
Description
Palavras-chave
cost-utility analysis, dacarbazine, melanoma, molecular targeted therapy
Citação
Guerra RL, Corrêa FM, Fernandes RRA, Zimmermann IR. Cost Utility of Target Therapies Compared to Dacarbazine for First-Line Treatment of Advanced Non-Surgical and Metastatic Melanoma in the Brazilian National Health System. Value in Health Regional Issues. 2019 jun;20:103-109. doi: 10.1016/j.vhri.2019.04.001.