Cancer care costs are a major concern for patients and society. We aimed to assess real life costs for the medical management of uMM.
We performed a retrospective patient chart review collecting data on demographics, disease characteristics and management. A complete registry of patients diagnosed with melanoma at the Antwerp University Hospital between 2007 and 12/2017 was compiled. Eligible for this chart review were all patients with uMM with sufficient data available and who either had an observation period of > 1 year at the time of this review or who deceased before December 31, 2017. Direct costs were calculated by multiplying each item of resource use, obtained from each individual patient chart, with its unit cost (2018, €) using the Belgian public health care payer’s perspective (PHCP) and patient’s perspective. A Kaplan–Meier sample average (KMSA) estimator was used to weight expected costs by the probability of survival and to adjust for censored data.
89 patients fulfilled all eligibility criteria for this chart review. Ten of the patients (11%) are still alive. 9 patients (10%) received best supportive care (BSC) only. 40 patients (45%) received > 1 immunotherapy or targeted agent. Mean overall monthly cost/patient for the entire cohort was € 7,244, of which € 7,153 was covered by the public health care payer. The cost was driven by systemic treatment costs (69% of cost). Median overall survival (OS) was 8.18 months (95 % CI: 6.0-10.3). Mean monthly overall cost was € 9,269 for patients (n = 40) with potential access to anti-PD1, anti-CTLA-4, BRAFi, and MEKi; median OS in this cohort was 13.83 months (95 % CI: 8.6-19.0). Mean monthly overall cost was € 3,258 for patients (n = 33) treated with chemotherapy/BSC only. Median OS in this cohort was 3.91 months (95 % CI: 2.2-5.6). Mean monthly overall cost was € 5,398 for patients (n = 16) who had access to anti-CTLA-4 and/or BRAFi but not to MEKi and anti-PD1. Median OS in these patients was 11.0 months (95 % CI 7.5-14.6).
Management of uMM results in considerable costs for the PHCP, mainly driven by systemic treatment costs. Also in a real-life setting, the introduction of immunotherapy and targeted agents substantially improved survival. However, mean monthly cost has nearly tripled.
Clinical trial identification
Legal entity responsible for the study
Antwerp University Hospital.
Has not received any funding.
All authors have declared no conflicts of interest.