Presentation (CTI)

OBJECTIVES: Melanoma is an aggressive skin cancer associated with substantial morbidity and mortality, especially in advanced stages. This analysis aimed to estimate the societal and economic impact of immunotherapy for melanoma in Bulgaria by modelling health outcomes and translating quality-adjusted life years (QALYs) gained into productivity-related economic value, focusing on working-age patients across different disease stages.
METHODS: A partitioned survival model (PSM) with three health states and a 3.5% annual discount rate over a lifetime horizon was developed. The model allows adaptation to other countries with similar data availability. QALY gains per patient were estimated based on melanoma stage, using survival and utility data from published clinical trials. Stage-specific health gains were multiplied by the number of treated patients in each group, based on real-world data from the Bulgarian National Health Insurance Fund (NHIF). Between 2021 and 2023, the number of melanoma patients treated with immunotherapy increased by 62%, reaching 419 individuals.
RESULTS: Economic productivity was calculated by combining the number of working-age patients, projected additional years lived within working age, and average annual GDP per employed person, using data from the National Statistical Institute. QALY gains were 11.08 for early-stage and 4.03 for advanced-stage melanoma patients. The total GDP contribution associated with these working-age patients was estimated at EUR 64,797,713.
CONCLUSIONS: Immunotherapy in melanoma provides substantial health and economic value, especially when introduced earlier in the disease course. The significant QALY gains and measurable GDP contributions underline the dual benefit of improving patient outcomes while supporting national economic productivity. In the Bulgarian context, these findings reinforce the importance of timely access to immunotherapy and integrating societal value considerations into national oncology planning.