Presentation (CTI)

OBJECTIVES: Melanoma is an aggressive malignancy associated with substantial clinical and socioeconomic burden, particularly in advanced and metastatic stages. Immunotherapy and targeted therapy have improved melanoma outcomes by prolonging survival and delaying progression. This analysis aimed to estimate added quality-adjusted life years (QALYs) and the associated contribution to gross domestic product (GDP) generated by these therapies in patients with adjuvant stage II-III and metastatic melanoma in Bulgaria.
METHODS: A health-economic model was developed using utility data from published clinical trials, together with market shares and numbers of treated patients based on real-world data from the Bulgarian National Health Insurance Fund (NHIF). A lifetime horizon and 3.5% annual discount rate were applied. Therapies included PD-1 inhibitors, combination immunotherapy, and BRAF/MEK targeted therapy combinations. The model estimated total QALY gains and monetized socioeconomic value through GDP contribution. Results were calculated separately for adjuvant and metastatic melanoma and aggregated across both settings.
RESULTS: In adjuvant stage II-III melanoma, 164 patients received immunotherapy or targeted therapy. The weighted average discounted QALY per patient was 10.99. Total added QALYs were estimated at 3,006.23, corresponding to a GDP contribution of €42.67 million. In metastatic melanoma, 456 patients were treated, with a weighted average discounted QALY per patient of 3.94. Total added QALYs were estimated at 2,253.30, corresponding to €40.35 million in GDP contribution. Overall, 620 patients received modern systemic therapy, generating 5,259.53 added QALYs and €83.02 million in total GDP contribution.
CONCLUSIONS: Immunotherapy and targeted therapy generate substantial health and socioeconomic value in melanoma in Bulgaria. The higher QALY gain per patient in the adjuvant setting indicates that earlier treatment initiation, before metastatic progression, may provide greater long-term benefit by preserving survival, quality-adjusted life expectancy, and productivity.