Качественная клиническая практика (Jul 2018)
Clinico-economic analysis of PD-1 inhibitors and combinations of BRAF and MEK inhibitors for the treatment of metastatic melanoma with a BRAF V600 gene mutation
Abstract
The high prevalence of BRAF V600 gene mutation in the Russian Federation and the cost of treatment the metastatic melanoma (MM) with immuno-oncology and combined targeted drugs make it relevant to assess the clinical and economic feasibility of their use. Objective. Cost-effectiveness analysis (CEA) and budget impact analysis (BIA) of PD-1 inhibitor pembrolizumab was performed in comparison with nivolumab and combinations of BRAF and MEK inhibitors in the 1st line therapy of MM with BRAF v600 gene mutation. Methodology. CEA and BIA was performed using the results of a network meta-analysis and based on the Markov model, which estimated the number of life years saved (LYS), duration of progression-free survival and direct medical costs (DC). Results. The cost of treatment per year in the 1st line therapy on pembrolizumab was 3.32 million RUB, what is 29 % cheaper than combination of dabrafenib + trametinib (4.67 million RUB), 60 % than vemurafenib + cobimetinib (8.30 million RUB), 1.7 % than nivolumab (3.38 million RUB). Total 3 years DC for the 1st line therapy on pembrolizumab (3.80 million RUB) were 43.9%, 68.2% and 1.8 % lower than the cost of dabrafenib + trametinib (6.76 million RUB), vemurafenib + cobimetinib (11.93 million RUB) and nivolumab (3.86 million RUB). CER per 1 LYS for pembrolizumab was 2.43 million RUB, nivolumab – 2.48 million RUB, dabrafenib + trametinib – 4.24 million RUB and vemurafenib + cobimetinib – 7.49 million RUB increase in the use of pembrolizumab to 50 %, by reducing the share of the use of combinations of BRAF and MEK inhibitors, will result in budget savings up to 1 507,5 million RUB (26.4 %). Conclusion. The use of pembrolizumab in the 1st line of MM therapy with BRAF V600 gene mutation allows to save the budget and is economically feasible.
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