Abstract
BackgroundThe objective of this study was to evaluate trends in survival and health care costs in metastatic melanoma in the era of targeted and immunotherapeutic drugs.Materials and methodsData on survival and health care resource use were retrieved from the Dutch Melanoma Treatment Registry. The Kaplan–Meier method was used to estimate overall survival. Health care costs and budget impact were computed by applying unit costs to individual patient resource use. All outcomes were stratified by year of diagnosis.ResultsBaseline characteristics were balanced across cohort years. The percentage of patients receiving systemic treatment increased from 73% in 2013 to 90% in 2018. Patients received on average 1.85 [standard deviation (SD): 1.14] lines of treatment and 41% of patients received at least two lines of treatment. Median survival increased from 11.8 months in 2013 [95% confidence interval (CI): 10.7-13.7 months] to 21.1 months in 2018 (95% CI: 18.2 months-not reached). Total mean costs were €100 330 (SD: €103 699); systemic treatments accounted for 84% of the total costs. Costs for patients who received systemic treatment [€118 905 (SD: €104 166)] remained reasonably stable over the years even after the introduction of additional (combination of) novel drugs. From mid-2013 to 2018, the total budget impact for all patients was €452.79 million.ConclusionOur study shows a gain in survival in the era of novel targeted and immunotherapeutic drugs. These novel drugs came, however, along with substantial health care costs. Further insights into the cost-effectiveness of the novel drugs are crucial for ensuring value for money in the treatment of patients with metastatic melanoma.
Highlights
Up until 2011, treatment options were limited for metastatic melanoma and survival was rather poor
Novel immunotherapeutic and targeted drugs became the standard of care for metastatic melanoma patients treated in Dutch clinical practice
Using population-based registry data from the nationwide Dutch Melanoma Treatment Registry (DMTR), we showed that median overall survival (OS) improved from 11.8 months in 2013 to 21.1 months in 2018
Summary
Up until 2011, treatment options were limited for metastatic (unresectable stage IIIc/ stage IV) melanoma and survival was rather poor. We showed that health care costs were much higher for patients who received systemic treatment (V105 078) compared to patients who did not receive systemic treatment (V7988).[11] In the Netherlands, w800-900 patients are annually diagnosed with metastatic melanoma and >80% is treated with at least one novel drug.[11]. The objective of this study was to evaluate trends in survival and health care costs in metastatic melanoma in the era of targeted and immunotherapeutic drugs. Costs for patients who received systemic treatment [V118 905 (SD: V104 166)] remained reasonably stable over the years even after the introduction of additional (combination of) novel drugs. Conclusion: Our study shows a gain in survival in the era of novel targeted and immunotherapeutic drugs These novel drugs came, along with substantial health care costs.
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