Use Patterns and Costs of Isolated Limb Perfusion and Infusion in the Treatment of Regional Metastatic Melanoma: A Retrospective Database Analysis

Abstract

IntroductionIsolated limb perfusion and infusion (ILP/ILI) are therapies for regional metastatic melanoma that allow high doses of anticancer drugs to be delivered directly into the circulation of an affected limb, thereby minimizing systemic drug toxicity. This procedure can lead to high response rates and is recommended in patients with Stage III unresectable metastatic melanoma. However, limited information is available on patterns of use and costs. This study examined patterns of ILP/ILI use and associated costs in patients with melanoma in the United States (US).MethodsRetrospective, observational study, using administrative claims data from the MarketScan® databases, was performed in patients with a diagnosis of melanoma (ICD-9-CM: 172.xx, V10.82) who underwent ILP/ILI (CPT-4: 36823) between January 1, 2002 and March 31, 2013. Patient characteristics, use patterns, length of hospital stay, and costs (per 2014 US $) of ILP/ILI were assessed.ResultsOne hundred and thirteen patients met the study criteria and were included in the analysis. Mean age was 61.4 years (standard deviation [SD] 13.8) and 38.9% of patients were male; the mean baseline Charlson Comorbidity Index was 0.19; 34.5% of patients were Medicare beneficiaries. The majority of patients (87.6%) had melanoma of the lower limb, 11.5% of the upper limb, and 0.9% of both limbs; 60.2% had lymph node metastasis and 56.6% had skin metastasis. Four patients (3.5%) underwent multiple ILP/ILI. The mean (±SD) length of hospital stay was 5.6 (±3.5) days and the mean (±SD) cost was US$36,758 (±27,124) per ILP/ILI procedure.ConclusionsIsolated limb perfusion and infusion in patients with melanoma were associated with long hospital stays and high costs. These results provide useful source data for the economic evaluation of treatment options for regional metastatic melanoma.FundingThis study was funded by Amgen, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-016-0283-z) contains supplementary material, which is available to authorized users.

Isolated limb perfusion and infusion in the treatment of melanoma and soft tissue sarcoma in the era of modern systemic therapies

“…Comparing ILP/ILI patients diagnosed with melanoma to those with STS, the melanoma patients were slightly older (mean 64 years for melanoma and 59 years for STS), consistent with previous reports of age at the time of procedure for each disease . The mean LOS (4.8 days) following ILP/ILI for melanoma in the current study was most consistent with what is reported in the literature for ILI .…”

“…Comparing ILP/ILI patients diagnosed with melanoma to those with STS, the melanoma patients were slightly older (mean 64 years for melanoma and 59 years for STS), consistent with previous reports of age at the time of procedure for each disease. [7][8][9][10]12,13,18,37,[39][40][41] The mean LOS (4.8 days) following ILP/ILI for melanoma in the current study was most consistent with what is reported in the literature for ILI. 42,43 The mean LOS for the STS patients who underwent ILP/ILI was slightly longer (7.0 days), and may suggest a higher proportion of patients undergoing ILP, which is typically associated with a longer LOS.…”

“…These national estimates have not previously been reported in the literature. Using an insurance claims database representing about 40 million privately‐insured and Medicare patients, Ma et al identified 113 ILP/ILI procedures between 2002 and 2013. Considering that the weighted estimates from NIS data represent national estimates, the data from the current study are consistent with the findings by Ma et al To the authors' best knowledge, the current study is the first to report a temporal trend in the utilization of ILP/ILI.…”

Does Locoregional Chemotherapy Still Matter in the Treatment of Advanced Pelvic Melanoma?

“…However, we defend our approach as necessary in order to minimize surgical procedure variability. Finally, although hypoxic pelvic perfusion is an expensive procedure, costs are similar to those incurred by isolated limb perfusion or infusion procedures for metastatic melanoma [ 26 ].…”

The role of regional chemotherapy for advanced limb melanoma in the era of potentially effective systemic therapies

“…Data to guide the duration of systemic therapy are lacking [66] and some patients may wish to travel to have a single episode of treatment with ILI or ILP rather than requiring the potentially indefinite administration of systemic therapies, requiring many attendances over a prolonged period. ILP/ILI are relatively expensive, with the mean overall treatment cost calculated at US$36 758 [67]. However, this is very much less than the cost of systemic therapy, which is at least US$100 000 per year [68].…”