Comparative healthcare costs in patients with metastatic melanoma in the USA

Abstract

Recent advances have increased treatment options for, and improved clinical outcomes in, metastatic melanoma (mM). Using a large claims database, this retrospective study compared healthcare and adverse event (AE) costs in a US managed care population of mM patients initiating vemurafenib (VEM), ipilimumab (IPI), dacarbazine (DTIC), paclitaxel (PAC), or temozolomide (TMZ) from July 2009 to September 2012. Treatment episodes were identified from the start of study drugs (index date) to a switch to a different study drug, or a gap greater than 45 days (>112 days for IPI). Grade 3/4 adverse events occurring ≥5% from study drug package inserts were selected for this analysis. All-cause costs for treatment episodes and AEs were normalized as monthly costs. Generalized estimating equation models with log link and gamma distribution provided adjusted monthly treatment episode and AE costs. A total of 809 treatment episodes were identified in 541 mM patients, with a mean (SD) age of 57.5 (11.5) years. The total mean (SD) all-cause cost per treatment episode for VEM was $77 687 ($60 329), for IPI was $153 062 ($134 048), for DTIC was $35 243 ($33 641), for TMZ was $42 870 ($41 384), and for PAC was $58 991 ($81 306). The adjusted mean monthly treatment episode cost for VEM was significantly lower than that for IPI and comparable to that for other drugs. VEM had a significantly lower monthly AE cost than IPI, DTIC, and PAC. In combination with safety and efficacy findings, these results may assist clinicians, patients, policy makers, and payers in the treatment of mM.

Direct costs associated with adverse events of systemic therapies for advanced melanoma

“…The included studies considered AEs associated with dabrafenib, dacarbazine, fotemustine, IL-2, interferon-alfa, IL-2, ipilimumab, paclitaxel, talimogene laherparepvec, temozolomide, trametinib, and vemurafenib. One study was a Canadian cost-effectiveness modeling analysis [ 21 ] ; 3 were economic burden analyses using published literature and physician interviews or a Delphi panel (1 conducted in the United States [US] [ 16 ] and 2 with a multicountry perspective [ 7 , 22 ] ); 2 were cost analyses using US claims data [ 15 , 23 ] ; and 1 was a United Kingdom (UK) medical records review. [ 24 ]…”

Postsurgical treatment landscape and economic burden of locoregional and distant recurrence in patients with operable nonmetastatic melanoma

“…Patients with distant recurrences had 186 more OP visits per 100 person-months in the year after recurrence compared with recurrence-free patients, whereas all-cause healthcare costs were higher by $14 953 PPPM in the year after recurrence. Previous studies in real-world USA populations have reported a range of $6773–62 859 PPPM for patients with metastatic melanoma 16 , 20 , 21 , 44 . Outside of the USA, including in developing countries, the cost per patient with melanoma was reported to range between $9162 and $86 875 14 , 45 – 47 .…”

“…No study to date has assessed HRU and costs associated with episodes of locoregional recurrences in this population. Furthermore, although several studies have assessed HRU and costs among patients with metastatic melanoma 16 – 21 , many are outdated because of major treatment advances for metastatic melanoma since 2011. This represents an important knowledge gap because recurrence is a key outcome for assessing burden of disease and informing decisions about the cost-effectiveness of therapies.…”

Economic burden of toxicities associated with treating metastatic melanoma in eight countries

“…The authors found that hemic and lymphatic disorders and effects incurred the highest costs across therapies. Adjusted mean costs for AEs were highest for dacarbazine and lowest for vemurafenib among the treatments considered [45]. …”