Establishing the 6-month resource utilization and cost-of-care for the treatment of first-line metastatic BRAF (+) melanoma with combination BRAF & MEK inhibitors

Comparative data on cancer therapy health care resource utilization (HCRU) and associated cost will be helpful as value-based healthcare moves forward. BRAF & MEK inhibitor combinations are considered first-line treatment for BRAF (V-600) metastatic melanoma (MM), although head-to-head trials are lacking. We aimed to establish the real-world HCRU and 6-month cost-of-care in V-600 MM treated with BRAF & MEK inhibitor therapy. A single data team performed a multicenter, retrospective chart audit of adult patients with BRAF V-600 MM. Four institutions from across the US with patients who had received either dabrafenib + Trametinib (DT) or vemurafenib + cobimetinib (VC) were enrolled and data was captured from the start of therapy for 6 months or until therapy was stopped. Dose change or stoppage was accessed for cause (toxicity, disease, death, other). Variables included hospitalization, emergency room (ER), all clinic visits (routine + extra), scans, labs, and treatment drug. Medicare reimbursed rates were applied for cost estimates. Further, utilization and costs were measured on per patient per month (PPPM) bases and the total cost over 6 months for each combination. Of the 42 patients included, 34 and 8 were initiated on DT and VC, respectively. PPPM hospitalization was the lowest among the resources utilized, 0.24 for DT and 0.17 for VC. A higher proportion of VC patients (75%) had a dose reduction due to drug toxicity compared with 29% of patients treated with DT (P<0.05). Discontinuation rates were the same between both combinations (~0.26). Thirty-two patients had completed 6 months of treatment (26 DT and 6 VC). For those DT, the mean total costs and the mean monthly total costs were $157,253 and $26,209 compared to $107,240 and $17,873 for VC, respectively. The mean total cost for hospitalization was $10,562 for DT and $7,456 for VC. The mean total cost for the drug was $145,012 for DT and $97,924 for VC. In conclusion, the 6-month total cost-of-care for the treatment of first-line V-600 MM with DT was $157,253 and $107,240 for VC, mostly attributable to drug cost. In a value-based healthcare system, the total 6-month cost-of-care may help distinguish between equally effective regimens.