Abstract
The use and detailed costs of services provided for people with advanced melanoma (amel) are not well known. We conducted an analysis to determine the use of health care services and the associated costs delineated by relevant attributable costs, which we defined for subjects in the province of Ontario. Through the Ontario Cancer Data Linkage Project, a cohort of amel patients with diagnoses between 31 August 2005 and 2012 (follow-up to 2013) and with valid International Classification of Diseases (9th revision, Clinical Modification) 172 codes and histology codes was identified. A cohort of individuals with amel having a combination of at least 1 palliative, 1 medical oncology, and 1 hospitalization code was generated. The health system services used by this population were clustered into hospitalization, palliation, physician medical visits, medication, homecare, laboratory, diagnostics, and other resources. Overall rates of use and disaggregated costs were determined by phase of care for the entire cohort. The mean age for the 2748 individuals in the cohort was 67 years. The greater proportion of the patients were men (65.6%) and were more than 65 years of age (>50%). In this advanced cohort, fewer than 45% of patients were alive 3 years after the malignant melanoma diagnosis. The average annual cost per patient over the time horizon was $6,551. At $15,830, year 1 after diagnosis was the most expensive, followed by year 2, at $8,166. Our data provide a baseline for the costs associated with amel treatment. Future studies will include newer agents and comparative effectiveness research for personalized therapies.
Highlights
Melanoma is a malignant tumour arising from melanocytes in the skin; it accounts for more than 95% of all melanomas[1]
Worldwide, approximately 132,000 people will be diagnosed with melanoma each year and that about 37,000 people will die of the disease annually[2]
In Canada, it is estimated that 6500 new cases of melanoma and 1050 melanoma-related deaths will occur in 2014 (3500 men and 3000 women will be diagnosed with melanoma, and 660 men and 400 women will die from it)[3]
Summary
Melanoma is a malignant tumour arising from melanocytes in the skin; it accounts for more than 95% of all melanomas[1]. Prognosis is related primarily to stage at diagnosis, which is determined by the thickness, ulceration, and mitotic rate of the primary lesion and by the presence and number of micro- or macrometastases in the regional lymph nodes or metastases at distant sites. For those diagnosed with stage iiic melanoma, 5-year survival is 40%4. The median survival duration for subjects with stage iv melanoma remains short, at approximately 6 months, with 26% of patients being alive at 1 year[5]. We conducted an analysis to determine the use of health care services and the associated costs delineated by relevant attributable costs, which we defined for subjects in the province of Ontario
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