1044P - Potential impact of new generation immunotherapy on years of life lost and lifetime earnings in metastatic melanoma

Date 28 September 2014
Event ESMO 2014
Session Poster Display session
Topics Bioethics, Legal, and Economic Issues
Skin Cancers
Presenter Kimary Kulig
Citation Annals of Oncology (2014) 25 (suppl_4): iv357-iv360. 10.1093/annonc/mdu341
Authors K. Kulig1, C. De Moor2, B. Korytowsky3, M. Halperin4, M. Danese4
  • 1Us Medical Oncology – Integrative Sciences, Bristol-Myers Squibb, 08536 - Plainsboro/US
  • 2Real-world Evidence (rwe) Solutions & Heor, IMS Health, Alexandria/US
  • 3Us Heor - Oncology (medical Affairs), Bristol-Myers Squibb, Plainsboro/US
  • 4N/a, Outcomes Insights, Inc., Westlake Village/US



Years of life lost (YLL) and lifetime earnings lost (LEL) are outcomes providing societal context for the burden of cancer relative to age, prevalence, life expectancy, and income. Melanoma is the 5th most common cancer in the US, and affects a relatively young population. Historical standard of care, including immune-based therapies interleukin-2 and interferon, afford a median survival for metastatic melanoma (MM) of less than a year (yr). Anti-CTLA4 immunotherapy has become a new standard therapy for MM. Anti-CTLA4 trial data show 32% reduction in the risk of death in previously untreated patients (HR 0.68, 95% CI 0.55 to 0.85) and pooled analyses have shown long-term survivorship up to 10 yrs in a subset of patients*. The goal of these analyses is to quantify YLL and LEL prior to the introduction of new generation immunotherapy and to model potential population-level effects of improved long-term survival on YLL and LEL.


Patients diagnosed with MM from Jan. 1, 2000 through Dec. 31, 2010 were identified from Surveillance, Epidemiology, and End Results (SEER) data and followed through Dec. 31, 2011. Age, sex, and race-specific life expectancy for MM patients were estimated using flexible parametric survival models. Comparable life expectancy estimates for the general US population were derived from US vital statistics data. Life expectancy estimates were combined with Bureau of Labor Statistics income data to estimate lifetime earnings for each population in 2014 dollars. Mean YLL and LEL were estimated as the differences between MM and the US general population.


An estimated 27,455 U.S. patients were diagnosed with MM from 2000-2010. We estimated these patients lost an average of 16.6 life years per patient (LYPP) and $18.3 billion in overall lifetime earnings. Reducing MM mortality rate by 10% would increase mean LYPP by 0.8 years, translating to $857 million in earnings for all MM patients diagnosed from 2000-2010. A 30% risk reduction would increase LYPP by 2.9 and earnings by $3.13 billion.


Improved long-term survivorship offered by new generation immunotherapy has potential to considerably decrease societal burden of MM as measured by YLL and LEL.


K. Kulig: Stock ownership: Bristol-Myers Squibb Corporate sponsored research: Bristol-Myers Squibb Other substantive relationships: Employee, Bristol-Myers Squibb; B. Korytowsky: Stock ownership: Bristol-Myers Squibb; M. Halperin and M. Danese: Corporate-sponsored research: Amgen, Inc; Genentech, Inc . All other authors have declared no conflicts of interest.