Resource utilization and disaggregated cost analysis for initial treatment of melanoma

Abstract

BackgroundEmerging new treatments and indications for melanoma therapy lend uncertainty to changing costs. We present a contemporary real-world microcosting analysis of initial melanoma therapy over twelve years. MethodsPatients with invasive cutaneous melanoma were identified retrospectively from the Ontario Cancer Registry (2003–2014) and deterministically linked with administrative databases through three separate algorithms. We identified comprehensively publicly funded resources utilized within a year of diagnosis, and costs related to various aspects of the healthcare continuum. Disaggregated, average-per-patient, and overall costs were presented, undiscounted, and from the perspective of the Canadian single-payer health system. Costs were ascribed to surgery, radiation, systemic therapy, physician billings, inpatient, and outpatient hospital sources. Results28,708 patients with invasive melanoma were identified. Median age at diagnosis was 63 years and 54% were male. The most common cost contributor was ambulatory surgery (48–62% of patients diagnosed each year) with a mean per-patient cost of $1796 CAD. Rates of systemic therapy use have remained stable over time (6–9% of patients diagnosed each year). Mean cost per-patient has increased starting in 2012, reflecting use of new medications with a maximum cost of $24,348 CAD reached in 2013. The total burden of cost was a maximum of $46.6MCAD for 3083 patients diagnosed in 2014 with a mean overall cost per patient of $15,132 CAD. ConclusionPatterns of resource utilization and costs for initial treatment of melanoma are changing, particularly due to systemic therapy. Understanding these patterns and forecasting of future changes are critical for sustainable budgetary planning.