ECONOMIC AND HUMANISTIC BURDEN OF DISTANT METASTASIS IN EARLY-STAGE MELANOMA: A SYSTEMATIC LITERATURE REVIEW
Author(s)
Christoffer Gerbhardt, MD1, Christopher Black, MPH, PhD2, Ina Zile, MS3, Kristen Markus, MS4, Maria Chrysostomou, MS5, Camille Chassat, MS6, Sameer Ghate, PhD2, Yuexin Tang, PhD7.
1University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, 2Merck & Co. Inc, Rahway, NJ, USA, 3Adelphi Values PROVE, Liverpool, United Kingdom, 4Adelphi Values PROVE, Alliston, ON, Canada, 5ADELPHI VALUES, London, United Kingdom, 6Adelphi Values Prove, London, United Kingdom, 7Merck & Co Inc, Rahway, NJ, USA.
1University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, 2Merck & Co. Inc, Rahway, NJ, USA, 3Adelphi Values PROVE, Liverpool, United Kingdom, 4Adelphi Values PROVE, Alliston, ON, Canada, 5ADELPHI VALUES, London, United Kingdom, 6Adelphi Values Prove, London, United Kingdom, 7Merck & Co Inc, Rahway, NJ, USA.
OBJECTIVES: Distant metastasis (DM) free survival is recognized as a clinically meaningful early-stage melanoma endpoint. This study assessed economic and humanistic outcomes associated with DM in early-stage melanoma.
METHODS: Embase, MEDLINE, and grey literature sources were systematically searched as per PRISMA guidelines. Studies from the past 10 years reporting DM and healthcare resource utilization/costs, or health-related quality of life (HRQoL) in adults with resectable/resected stage IIB-IV melanoma were included. Quality was assessed using Cochrane and JBI tools. Data were synthesized narratively.
RESULTS: For economic outcomes, five retrospective studies (US [n=2], Europe [n=1], Netherlands [n=1], Spain [n=1]) consistently demonstrated significant costs associated with DM. In one US study, DM was associated with +$14,953 per-patient-per-month (PPPM) vs. recurrence-free controls. Another study showed additional $6,670 PPPM vs. locoregional recurrence (LR) in stage IIB/C and $7,235 PPPM in stage III disease. In Europe, hospitalization rates were higher in DM vs. LR in stage IIIB/C patients (66% vs. 57.6%). In the Netherlands, mean per-episode costs were €10,393 for DM vs. €4,414 for LR. In Spain, total annual costs increased significantly after recurrence (€56,970 vs €5,255), with over half of recurrences being distant. Four studies assessed HRQoL associated with DM/recurrence. A global trial showed recurrence associated with significant declines in EQ-5D-3L utility (-0.077) and EQ-5D-VAS (-6.01), and another trial showed DM having a detrimental effect on EORTC global health score (mean effect -6.12). In a Serbian cohort of stage IIC-IIIC melanoma patients, DM was a strong predictor of poorer HRQoL (-22.38). The Europe cohort study reported lowest EQ-5D-3L utility in patients with DM (0.71) vs. 0.79 and 0.80 for disease-free and LR respectively. All included studies had low risk of bias.
CONCLUSIONS: Experiencing a DM in early-stage melanoma is associated with a substantial economic and humanistic burden highlighting the importance of adjuvant strategies that prevent or delay distant recurrence.
METHODS: Embase, MEDLINE, and grey literature sources were systematically searched as per PRISMA guidelines. Studies from the past 10 years reporting DM and healthcare resource utilization/costs, or health-related quality of life (HRQoL) in adults with resectable/resected stage IIB-IV melanoma were included. Quality was assessed using Cochrane and JBI tools. Data were synthesized narratively.
RESULTS: For economic outcomes, five retrospective studies (US [n=2], Europe [n=1], Netherlands [n=1], Spain [n=1]) consistently demonstrated significant costs associated with DM. In one US study, DM was associated with +$14,953 per-patient-per-month (PPPM) vs. recurrence-free controls. Another study showed additional $6,670 PPPM vs. locoregional recurrence (LR) in stage IIB/C and $7,235 PPPM in stage III disease. In Europe, hospitalization rates were higher in DM vs. LR in stage IIIB/C patients (66% vs. 57.6%). In the Netherlands, mean per-episode costs were €10,393 for DM vs. €4,414 for LR. In Spain, total annual costs increased significantly after recurrence (€56,970 vs €5,255), with over half of recurrences being distant. Four studies assessed HRQoL associated with DM/recurrence. A global trial showed recurrence associated with significant declines in EQ-5D-3L utility (-0.077) and EQ-5D-VAS (-6.01), and another trial showed DM having a detrimental effect on EORTC global health score (mean effect -6.12). In a Serbian cohort of stage IIC-IIIC melanoma patients, DM was a strong predictor of poorer HRQoL (-22.38). The Europe cohort study reported lowest EQ-5D-3L utility in patients with DM (0.71) vs. 0.79 and 0.80 for disease-free and LR respectively. All included studies had low risk of bias.
CONCLUSIONS: Experiencing a DM in early-stage melanoma is associated with a substantial economic and humanistic burden highlighting the importance of adjuvant strategies that prevent or delay distant recurrence.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE707
Topic
Economic Evaluation, Patient-Centered Research
Topic Subcategory
Value of Information
Disease
Oncology