Treatment.specific utility weightings are needed for cost.utility analysis in metastatic melanoma

摘要

Dear Editor, We read .with interest the article by Matter. Walstra et al., who offer a cost.utility analysis of trametinib. dabrafenib combination treatment compared with vemurafenib monotherapy for BRAF mutant metastatic melanoma. The authors concluded that the combination treatment cost an additional CHF199 647 and offered 0.52 additional quality. adjusted life years (QALYs), generating an incremental cost. effectiveness ratio (ICER) of CHF38S 603/QALY. Sensitivity analysis demonstrated that utility parameters had the strongest impact on the ICER, yet the utility weightings employed for patients receiving trametinib.dabrafenib treatment were those generated from patients treated with trametinib alone. These treatments should not be considered equivalent, as their efficacy and safety profile are different, and their utility weightings would differ accordingly. BRAF inhibitor monotherapy is associated with a notable cutaneous toxicity profile, including squamous cell carcinoma (SCC), keratoacanthoma, photo. sensitivity, Grover disease and palmoplantar hyperkeratosis. Combination therapy is associated with a significant decrease in the incidence of these adverse effects (e.g. the frequency of SCC was 1% in the cohort receiving combination therapy compared with 18% in the cohort receiving vemurafenib), albeit with an increased frequency of milder side.effects such as acneiform eruptions.4'7 While the costs associated with the cutaneous toxicities were considered in the cost.utility analysis, the decrement in quality of life (QoL) they impose appears to have been overlooked as the utility weightings employed for the progression.free survival state were 0.80 for vemurafenib but 0.78 for combination treatment.