HEALTHCARE RESOURCE UTILIZATION (HCRU) AND ASSOCIATED COSTS IN PATIENTS WITH STAGE III MERKEL CELL CARCINOMA (MCC) TREATED WITH FIRST-LINE (1L) AVELUMAB IN A REAL-WORLD SETTING: RESULTS FROM THE MCC-TRIM REGISTRY
Author(s)
Hamid Mahmoudpour, PharmD, PhD1, Selma Ugurel, MD2, Dirk Schadendorf, MD, PhD3, Ulrike Leiter, MD4, Friedegund Meier, MD5, Rudolf Herbst, MD6, Michael M. Sachse, MD7, Stephan Grabbe, MD8, Christoffer Gebhardt, MD9, Fabian Ziller, MD10, Claudia Pföhler, MD11, Peter Mohr, MD12, Sebastian Hoff, MD1, Emmanuelle Boutmy, PhD1, Mairead M. Kearney, MBA, MPH, MSc, MD1, Margarita Shlaen, MPH13, Jürgen C. Becker, MD, PhD14.
1Merck Healthcare KGaA, Darmstadt, Germany, 2Department of Dermatology, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Bielefeld - Rosenhöhe, Bielefeld, Germany, 3Department of Dermatology, University Hospital Essen; German Cancer Consortium, Partner Site Essen; National Center for Tumor Diseases (NCT), NCT-West, Campus Essen; and Research Alliance Ruhr – Research Center One Health, University Duisburg-Essen, Essen, Germany, 4Department of Dermatology, Center for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen, Germany, 5Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; and Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany, 6Department of Dermatology, Helios Klinikum Erfurt, Erfurt, Germany, 7Department of Dermatology, Allergology and Phlebology, Klinikum Bremerhaven-Reinkenheide, Bremerhaven, Germany, 8Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany, 9Department of Dermatology and Venereology, University Skin Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, 10Department of Dermatology, DRK Krankenhaus Rabenstein, Chemnitz, Germany, 11Department of Dermatology, Venereology and Allergology, Saarland University Medical School, Homburg-Saar, Germany, 12Department of Dermatology, Elbe Kliniken, Buxtehude, Germany, 13IQVIA Commercial GmbH & Co. OHG, München, Germany, 14Departments of Translational Skin Cancer Research and Dermatology, University Hospital Essen, Essen, Germany; and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, German Cancer Research Center (DKFZ), Heidelberg, Germany.
1Merck Healthcare KGaA, Darmstadt, Germany, 2Department of Dermatology, Bielefeld University, Medical School and University Medical Center OWL, Klinikum Bielefeld - Rosenhöhe, Bielefeld, Germany, 3Department of Dermatology, University Hospital Essen; German Cancer Consortium, Partner Site Essen; National Center for Tumor Diseases (NCT), NCT-West, Campus Essen; and Research Alliance Ruhr – Research Center One Health, University Duisburg-Essen, Essen, Germany, 4Department of Dermatology, Center for Dermatooncology, Eberhard Karls University of Tübingen, Tübingen, Germany, 5Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; and Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany, 6Department of Dermatology, Helios Klinikum Erfurt, Erfurt, Germany, 7Department of Dermatology, Allergology and Phlebology, Klinikum Bremerhaven-Reinkenheide, Bremerhaven, Germany, 8Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany, 9Department of Dermatology and Venereology, University Skin Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany, 10Department of Dermatology, DRK Krankenhaus Rabenstein, Chemnitz, Germany, 11Department of Dermatology, Venereology and Allergology, Saarland University Medical School, Homburg-Saar, Germany, 12Department of Dermatology, Elbe Kliniken, Buxtehude, Germany, 13IQVIA Commercial GmbH & Co. OHG, München, Germany, 14Departments of Translational Skin Cancer Research and Dermatology, University Hospital Essen, Essen, Germany; and German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, German Cancer Research Center (DKFZ), Heidelberg, Germany.
OBJECTIVES: MCC is a rare and aggressive skin cancer. In Europe, avelumab is widely approved and reimbursed as a monotherapy for patients with metastatic MCC (stage IV). This study aimed to describe HCRU and associated costs in patients diagnosed with stage III MCC receiving 1L avelumab treatment in routine clinical practice in Germany.
METHODS: Data were analyzed from the MCC-TRIM registry, a prospective, noninterventional, multicenter cohort in Germany. In this analysis, patients diagnosed with or whose disease had progressed to unresectable stage III MCC and received 1L avelumab treatment were recruited between April 2019 and September 2023. All-cause HCRU was assessed as units and associated direct medical costs reported per person per month (PPPM) to account for variable follow-up. Resources evaluated included outpatient and emergency department visits, hospitalizations, and imaging procedures.
RESULTS: Overall, 98 patients were diagnosed with stage III MCC and received 1L avelumab; 65.3% were male, 81.6% had stage IIIB disease, and mean age at avelumab initiation was 78.2 years (SD, 9.2). ECOG performance status in patients with available data (n=65) was 0 in 56.9%, 1 in 35.4%, and 2 in 7.7%. Median number of outpatient visits was 0.7 PPPM (Q1-Q3, 0.2-1.7), with associated median healthcare costs of €18 PPPM (Q1-Q3, €7-€56) and mean costs of €35 PPPM (SD, €40). Median number of hospitalizations was 0.06 PPPM (Q1-Q3, 0-0.15), with associated median costs of €160 PPPM (Q1-Q3, €0-€441) and mean costs of €331 PPPM (SD, €522). In deceased patients (n=29), mean total costs increased from €242 PPPM (SD, €583) >12 months prior to death to €2,414 PPPM (SD, €4,833) within the last 3 months before death.
CONCLUSIONS: This real-world study provides novel insights into HCRU in patients with stage III MCC receiving 1L avelumab treatment. PPPM costs were highly concentrated in the last few months prior to death. Future studies are warranted.
METHODS: Data were analyzed from the MCC-TRIM registry, a prospective, noninterventional, multicenter cohort in Germany. In this analysis, patients diagnosed with or whose disease had progressed to unresectable stage III MCC and received 1L avelumab treatment were recruited between April 2019 and September 2023. All-cause HCRU was assessed as units and associated direct medical costs reported per person per month (PPPM) to account for variable follow-up. Resources evaluated included outpatient and emergency department visits, hospitalizations, and imaging procedures.
RESULTS: Overall, 98 patients were diagnosed with stage III MCC and received 1L avelumab; 65.3% were male, 81.6% had stage IIIB disease, and mean age at avelumab initiation was 78.2 years (SD, 9.2). ECOG performance status in patients with available data (n=65) was 0 in 56.9%, 1 in 35.4%, and 2 in 7.7%. Median number of outpatient visits was 0.7 PPPM (Q1-Q3, 0.2-1.7), with associated median healthcare costs of €18 PPPM (Q1-Q3, €7-€56) and mean costs of €35 PPPM (SD, €40). Median number of hospitalizations was 0.06 PPPM (Q1-Q3, 0-0.15), with associated median costs of €160 PPPM (Q1-Q3, €0-€441) and mean costs of €331 PPPM (SD, €522). In deceased patients (n=29), mean total costs increased from €242 PPPM (SD, €583) >12 months prior to death to €2,414 PPPM (SD, €4,833) within the last 3 months before death.
CONCLUSIONS: This real-world study provides novel insights into HCRU in patients with stage III MCC receiving 1L avelumab treatment. PPPM costs were highly concentrated in the last few months prior to death. Future studies are warranted.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE684
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology