Targeted Therapies Compared to Dacarbazine for Treatment of BRAF^V600E Metastatic Melanoma: A Cost-Effectiveness Analysis

Table 1

Model inputs.

	Vemurafenib	Dabrafenib		Dacarbazine
Base case adverse event probabilities by drug [4, 6]
Vomiting, nausea, Grades 1, 2	0.0023	0.0009		0.0106
Vomiting, nausea, Grades 3, 4	0.0010	0		0.0007
Diarrhea, Grades 1, 2	0.0230	0		0.0006
Diarrhea, Grades 3, 4	0.0005	0		0.0001
Hyperkeratosis, Grades 1, 2	0.0172	0.0113		0
Hyperkeratosis, Grades 3, 4	0.0010	0.0009		0
Skin papilloma, Grades 1, 2	0.0169	0		0
Skin papilloma, Grades 3, 4	0	0		0
Squamous cell carcinoma, Grades 1, 2	0	0.0018		0
Squamous cell carcinoma, Grades 3, 4	0.0105	0.0036		0
Keratoacanthoma, Grades 1, 2	0.0051	0		0
Keratoacanthoma, Grades 3, 4	0	0		0
Neutropenia, Grades 1, 2	0.0002	0		0.0019
Neutropenia, Grades 3, 4	0.0002	0.0004		0.0086
PPE, Grades 1, 2	0	0.0055		0
PPE, Grades 3, 4	0	0.0018		0
Leukopenia, Grades 1, 2	0	0		0.0013
Leukopenia, Grades 3, 4	0	0		0.0007
Thrombocytopenia, Grades 1, 2	0	0		0
Thrombocytopenia, Grades 3, 4	0	0		0.0020
	Base case value	Sensitivity analysis		Distribution
		Lower value	Upper value
Drug-specific utility values for each health state including side effects
Stable disease, dacarbazine	0.69	0	1	Beta
Progression, dacarbazine	0.45	0	1	Beta
Stable disease, dabrafenib	0.79	0	1	Beta
Progression, dabrafenib	0.52	0	1	Beta
Stable disease, vemurafenib	0.73	0	1	Beta
Progression, vemurafenib	0.49	0	1	Beta
Monthly drug costs (2013 USD)
Dacarbazine cost per month, assuming one cycle per month and including administration and prophylactic antiemetic treatment costs [12–14]	$988.86	$678.29	$1356.85	Gamma
Dabrafenib monthly cost [6, 13]	$7569.60	$5677.20	$9462.00	Gamma
Vemurafenib monthly cost [4, 13]	$10807.40	$8105.55	$13509.25	Gamma
Toxicity management costs per month on treatment
Hyperkeratosis, Grades 1, 2 [13, 15, 16]	$126.66	$114.26	$424.95	Gamma
Hyperkeratosis, Grades 3, 4 [13, 15, 16]	$1082.84	$1070.84	$1706.93	Gamma
Squamous cell carcinoma [15, 17]	$1595	$1128	$3408	Gamma
Nausea, vomiting BRAF inhibitor, Grades 1, 2 [12, 13]	$274.58	$274.58	$419.54	Gamma
Nausea, vomiting BRAF inhibitor, Grades 3, 4 [12–14]	$6855.76	$4480.05	$8009.39	Gamma
Diarrhea, Grades 1, 2 [13, 18]	$5.81	$5.81	$45.89	Gamma
Diarrhea, Grades 3, 4 [13–15, 18]	$7404.11	$3550.28	$7845	Gamma
Keratoacanthoma, Grades 1, 2 [6, 13, 15]	$113.67	$66.72	$181.31	Gamma
Skin papilloma, Grades 2, 3 [15]	$73	$61	$97	Gamma
PPE [13, 15, 19, 20]	$113.67	$113.67	$178.62	Gamma
Nausea, vomiting, dacarbazine, Grades 1, 2 [12, 13]	$84.66	$2.78	$4485.98	Gamma
Nausea, vomiting, dacarbazine, Grades 3, 4 [12–14]	$6665.84	$4208.25	$12075.84	Gamma