Economic evaluation of adverse events of dabrafenib plus trametinib versus nivolumab in patients with advanced BRAF-mutant cutaneous melanoma for adjuvant therapy in Germany

authored by

S Wahler, A Müller, C Koll, P Seyed-Abbaszadeh, Johann-Matthias Graf von der Schulenburg

Abstract

Background: Adjuvant treatment options have become the standard therapy for stage III and IV resectable cutaneous melanoma. Two recent studies led to the registration of dabrafenib and trametinib as targeted therapies for BRAF-mutated melanoma, and of immunotherapy with nivolumab irrespective of BRAF-mutation status. Both therapies have different spectrums of adverse events. Objective: To estimate the financial impact of side effects from the perspective of the German statutory sick funds to compare both therapeutic options and to relate the burden to the overall costs of the treatment.

STUDY DESIGN AND SETTING: Thirty-six adverse event categories for the combination of dabrafenib and trametinib ('combi treatment') and for nivolumab were extracted from the original publications of the studies named COMBI-AD and CheckMate 238.

PATIENTS AND INTERVENTION: For all event categories a diagnosis and therapy recommendation were determined according to current national or international guidelines or from leading German textbooks.

MAIN OUTCOME MEASURE: The resulting diagnostic steps, treatments, and therapies were evaluated with unit costs based on the German fee schedule for ambulatory physicians, the German G-DRG scheme, and the German drug price list.

RESULTS: The number of events with nivolumab per one hundred treatments amounted to 3.8 mandatory hospitalizations, 3.5 emergency care events and 0.8 life-threatening events. For the combi treatment, the respective number of events per one hundred treatments was 2.7, 1.8, and 0.5. The overall cost burden was calculated as €899 for nivolumab and €861 for combi-treatment.

CONCLUSION: The treatment of adverse events resulting from adjuvant melanoma therapy showed comparable costs for both therapies.

Organisation(s)

Institute of Insurance Business Administration

External Organisation(s)

St. Bernward GmbH
Analytics Services GmbH
Diabetes Praxis Blankenese
Hamburg University of Technology (TUHH)

Type

Article

Journal

Journal of market access & health policy

Volume

ISSN

2001-6689

Publication date

2021

Publication status

Published

Peer reviewed

Yes

ASJC Scopus subject areas

Health Policy, Health Informatics

Sustainable Development Goals

SDG 3 - Good Health and Well-being

Electronic version(s)

https://doi.org/10.1080/20016689.2020.1861804 (Access: Open)